ACE, 15-9.53Bgp. BOROUGH OF HORNSEY REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 Ac439() ITAR ACEY. HoR. 044 HOR.044 BOROUGH OF HORNSEY REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 MEMBERS OF THE COUNCIL *Alderman G. W. F. Pallett, j.p., Mayor Alderman M. W. Burns, Deputy Mayor ALDERMEN F. H. Bailey, j.p. N. Muldoon, j.p. *E. C. Castle H. F. Nichols Mrs. C. M. Cave G. F. N. Norman *S. G. Goulding *T. Tivendale Sir Wm. J. Grimshaw, j.p. *L. J. Valette COUNCILLORS *R. G. Aitken A. S. Kent †*Miss O. R. Anderson *A. M. Kisby (Vice-Chairman of Area Health Com.) E. M. Larard L. A. Bains J. C. O. Lawrence S. A. Ball Mrs. W. L. Le Messurier *Miss A. G. Bell R. G. Leeming D. F. W. Billingsley *J. Lindsey *R. A. Butler, j.p. H. L. Norman (Chairman of Health Com) †*Mrs. D. F. Nott L. G. Capes †*Miss J. Richardson F. C. Cave, j.p. J. R. Richardson H. P. Creasy *P. G. Stapley Mrs. K. M. St. P. Crump R. F. Sutton O. J. R. de Boer †-*C. V. Tipping P. F. H. Emery †*Miss M. Toyne J. F. Ford G. Watson H. A. Goodwin R. J. G. Watt P. Hardiman *Miss M. E. West R. J. Hooker C. R. Williams *Member of Health Committee at 31st December, 1952. †Member of Area Health Committee at 31st December, 1952. 2 Health Department, Town Hall, Hornsey, N.8. To His Worship the Mayor, the Aldermen and the Councillors of the Borough of Hornsey Mr. Mayor, Ladies and Gentlemen, I beg to present my Annual Report on the health of the Borough and the work of the public health department for the year ended 31st December, 1952. The publication of this report coincides with Hornsey's Jubilee celebrations as a Municipal Borough under Royal Charter of Incorporation. Over this fifty-year period annual reports of the Borough's medical officers of health have given striking evidence of continuous progress in the sphere of public health: in prevention of disease and betterment of the environmental conditions in which the local community lives and works. The story too is told of the establishment and expansion of the personal health services; of the vision, energy and enthusiasm of the Corporation's committees concerned, for so many years, with education and maternity and child welfare, in addition to the work of the public health committee. The origin and growth of the school medical service; and the growth of the priority care for the expectant and nursing mother and for the young child below school age. The provision of an isolation hospital for the treatment of infectious disease, a maternity hospital and the erection of clinic premises and nurseries designed to serve their special purposes. All those who appreciate the value of things felt and done locally may still feel some apprehension by the turn of events since the last world war and the transfer away from the Borough of much of the control over these and other local government services. Statistics which have to be shown in Annual Reports of this kind are sometimes regarded as dull reading ; but in fact the data they contain are the only real means we have of assessing past progress and of promoting future endeavour to meet the requirements of changing trends in the pattern of health and disease. In this respect some comparison may be drawn with conditions that existed at the opening of the century fifty years ago. In the year 1902 the population of the Borough was 73,992; today this figure has risen to 99,140. The total area was 2,874 acres compared with 2,872 acres at the present time giving a density of population representing 25.7 persons per acre as compared with the density now of 34.5. The birth rate then was 20.7 a figure considerably lower than that of 28.3 per thousand inhabitants for the whole of England and Wales. In Hornsey today the birth rate is 14.4 and is still lower than 3 the national figure of 15.3 per thousand population. The infantile death rate in the year 1902 was 83.3 per thousand live births, which compared favourably with other large towns of the period and that of 130 per thousand in London. In those days epidemic diarrhoea caused a heavy toll on infant life and the medical officer of health referred then to the risks of food contamination, particularly milk. He suggested among other things that "all milk should be kept in covered vessels to protect it from flies and dust; strict cleanliness (personal and otherwise) is essential and the cleansing and watering of streets in hot dusty weather is very important." This must be one of the earliest attempts made in Hornsey to educate the public in food hygiene. On instructions of the public health and hospital committee the medical officer of health wrote a leaflet giving simple instructions as to the feeding of infants arid precautions to be taken. These were distributed in the poorer parts of the district by lady visitors associated with the churches in the Borough. The infantile death rate in Hornsey today is 17.5 per thousand births, a low record by comparison with that of fifty years ago and with the present figure of 27.6 for England and Wales. The general death rate in Hornsey fifty years ago was 8.4 per thousand inhabitants which was low, not only by comparison with that of 17.2 then in London but also with the figure of 11.6 in Hornsey today. The favourable circumstances in Hornsey's death rate at the beginning of the century can be at least partially explained by the rapid development and influx of a relatively young population in the previous decade. Commenting on this and other favourable vital statistics of the Borough the then medical officer of health wrote "almost the only point to which one cannot allude with feelings of satisfaction is the increased mortality from tuberculosis." He estimated that between 250 and 300 persons in the Borough were suffering from tuberculosis, probably a much underestimated figure. (Tuberculosis was not a notifiable disease at that time.) Eleven per cent, of the total deaths in this year were said to be caused by "pulmonary consumption," and a report to the Health Committee stressed the importance of preventive measures and the duty of a health authority to raise the standard of living in its district in an endeavour to stamp out this disease. Later a sub-committee was set up to consider the provision of hospital treatment for the tuberculosis patient, as it was felt that there was then little hope of a sanatorium being established for the whole county. Emphasis was placed not only on the curative value of such a sanatorium, but also on its educational and preventive aspects. By 1910, after visits had been paid to various sanatoria, the public health committee recommended to the Town Council that similar provision should be made in Hornsey by combining with adjacent Authorities. In the following year a conference of representatives of the County, Borough and Urban District Councils in Middlesex passed a resolution to the effect that local authorities individually or in combination should establish (1) a tuberculosis dispensary, (2) make local provision for the loan of open-air shelters to tuberculosis patients, (3) sanatorium accommodation for the treatment of this disease. Further that the Local Government Board be requested to introduce compulsory, notification of all cases of tuberculosis. Since that day much has been 4 done to ensure the early detection of this disease—the wide expansion of tuberculosis dispensaries (chest clinics as they are now called) and by the more recent introduction of mass radiography. Advances in therapy, too, have seen a substantial decline in the number of deaths from tuberculosis. Better standards of milk production and supervision of slaughterhouses have given rise to a lower incidence in the number of cases of non-pulmonary tuberculosis. Prevention of the spread of infection, however, in the case of pulmonary tuberculosis is still a major problem of the present day. Overcrowding aggravated by difficulties of rehousing, resulting mainly from the effects of two world wars, is still very much the concern of our public health service. As shown elsewhere in this Report progress is now being made year by year in the improvement of housing conditions including the welcome resumption of "clearance area" procedure; and vigorous action by the health department to ensure the repair of an increasing number of unfit and insanitary houses under the appropriate sections of the Public Health or Housing Acts. Attention too has been given to the subject of atmospheric pollution and its relation particularly to the toxic effects of one of the severest fogs experienced in the Greater London area during the month of December, 1952. By comparison with the early days of Public Health the control of the then more common infectious diseases continues to be satisfactory. Diphtheria, scarlet fever and measles are no longer the killing diseases they were, and no deaths occurred in Hornsey from any of these diseases during the past year. To ensure the maintenance of such a record for diphtheria, as in the case of smallpox, the public needs to be constantly reminded of the necessity to take advantage for their children of the methods of protection gained by immunisation and vaccination respectively. A striking comparison with conditions as they existed in the health services of fifty years ago can be drawn in the now accepted responsibility that local authorities have for the individual at the extremes of life. Already mention has been made of the progress made in the care of children; but no review of the health services today would be complete without reference to a growing recognition of responsibility for the special needs of an ageing population. Gone are the days of the poor law system and of the association of old age with the workhouse. Hospital, general medical practitioner, health and welfare committees of the county council and the borough council all have statutory duties in providing what may become a truly comprehensive service for the welfare and care of aged people in need. In Hornsey, too, we are fortunate in having much voluntary enterprise in this work. The establishment of old people's homes, clubs and other activities many of which are allied to a most active Old People's Welfare Committee representing many aspects of local civic life. In conclusion I should like to take this opportunity of acknowledging my appreciation of the ready and willing help given to me by all my 5 colleagues in the Health Department; and the very real co-operation of the Town Clerk and Chief Officers and their staffs in other Departments. To the Chairman (ex-Councillor R. A. Butler, j.p.) and members of the Health Committee I am specially indebted for their support and encouragement in a service of expanding functions and human interest. I am, Your obedient servant, G. Hamilton Hogben, 1st September, 1953. Medical Officer of Health. CONTENTS Page SOCIAL AND ECONOMIC STATISTICS 8 SANITARY CIRCUMSTANCES Housing and Health 15 Campsbourne Clearance Area 16 Demolition and Closing Orders 17 Pure Air 18 Atmospheric Pollution 18 Water Supply 23 Pollution of the Moselle 24 Workplaces not covered by Factories Acts 26 Inspection of Shops 27 Rodent Control 27 Licensing of Pet Shops 28 Housing Inspections 29 Notices Served 29 Inspection of Factories 30 Inspections by Sanitary Inspectors 31 Summary of Sanitary Improvements Effected 32 Legal Proceedings 33 FOOD Inspection of Food Premises 37 Legal Proceedings 38 Milk Supply 38 Ice Cream 39 Bakehouses 39 Slaughterhouses 39 Hawkers of Food 40 Premises for the Manufacture of Preserved Foods 40 Inspection of Food Premises—Table 40 Condemned Food 40 Food Sampling 41 INFECTIOUS DISEASES Diphtheria Immunisation 43 Laboratory Services 44 Notification of infectious disease by Age and Sex 46 Notification of infectious disease by Wards 47 Tuberculosis, cases on Register 48 GENERAL Medical Examination of Staff 51 Local Health Services 51 Medical Practitioner Services 51 Hospital Services in Hornsey 52 Massage and Special Treatment 53 National Assistance Act, 1948 54 Veterinary Inspections 55 Public Mortuary 55 APPENDIX REPORT OF THE AREA MEDICAL OFFICER 57 7 SOCIAL AND ECONOMICAL STATISTICS Area (acres) 2,872 Area of Parks and Open Spaces (acres) 576 Population : Census 1931 95,524 Census 1951 98,134 Registrar General's estimate at 30 June, 1952 99,140 Number of separately assessed inhabited premises according to Rate Books 24,911 Rateable value (General Rate) £1,075,040 Product of a penny rate £4,350 VITAL STATISTICS LIVE BIRTHS M F Total Legitimate 701 661 1,362 Illegitimate 33 36 69 734 697 1,431 Birth Rate (per 1,000 population) Hornsey 14.4 Area Comparability Factor 0.89 Adjusted Rate For Hornsey 12.82 England and Wales 15.3 160 Great Towns 16.9 160 Smaller Towns 15.5 London Administrative County 17.6 STILL BIRTHS M F Total Legitimate 12 13 25 Illegitimate 1 1 2 13 14 27 Still-birth Rate (per 1,000 population) Hornsey 0.27 England and Wales 0.35 160 Great Towns 0.43 160 Smaller Towns 0.36 London Administrative County 0.34 8 INFANT DEATHS (under 1 year of age) M F Total Legitimate 19 4 23 Illegitimate 2 — 2 21 4 25 Comparable Infant Death Rates (per 1,000 live births) Hornsey 17.5 England and Wales 27.6 160 Great Towns 31.2 160 Smaller Towns 25.8 London Administrative County 23.8 Legitimate Illegitimate Neo-Natal Deaths (under 4 weeks of age) M F Total 17 4 21 MATERNAL DEATH RATES (per 1,000 total live and still-births) Hornsey (one death only) 0.69 England and Wales 0.72 NOTIFICATIONS OF PUERPERAL PYREXIA Number of Notifications 12 Puerperal Pyrexia Rate (per 1,000 total live and stillbirths) Hornsey 8.23 England and Wales 17.87 160 Great Towns 23.94 160 Smaller Towns 10.22 London Administrative County 30.77 9 DEATHS FROM ALL CAUSES Males 521 Females 631 1,152 Death Rate (per 1,000 population) Hornsey 11.6 Area Comparability Factor 0.92 Adjusted Rate For Hornsey 10.67 England and Wales 11.3 160 Great Towns 12.1 160 Smaller Towns 11.2 London Administrative County 12.6 DEATHS OF HORNSEY RESIDENTS Classified according to age groups Under 1 1 to 2 2 to 4 5 to 14 15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and over Totals 1 Tuberculosis, respiratory M . . . . . . 2 2 3 5 . 12 19 F . . . . . 1 1 3 • 2 . 7 2 Tuberculosis, other M . . . . . . . . . . . 1 03 F . . . . . . . 1 . . 1 2 3 Syphilitic disease M . . . . . 1 . 1 . 1 1 4 5 F . . . . . . . . . . 1 1 6 Meningococcal infections M . . . . . . . . . . . 1 1 F . . . . . . . . . . . . 9 Other infective and parasitic diseases M . . . . . . . . 1 . . 1 5 F . . . . . . . . . 4 . 4 10 : Malignant neoplasm, stomach M . . . . . . 1 2 . 2 5 10 25 F . . . . . . 2 . 3 5 5 15 11 Malignant neoplasm, lung, bronchus M . . . . . . 1 3 8 8 5 25 35 F . . . . . . . . 1 4 5 10 12 Malignant neoplasm, breast M . . . . . . . . . . . . 29 F . . . . . . 2 1 11 9 5 29 13 Malignant neoplasm, uterus M . . . . . . . . . . . . 12 F . . . . . . 1 1 3 3 4 12 14 Other malignant and lymphatic neoplasms m . . 1 . 1 1 1 1 13 12 22 52 119 F . . . 1 1 1 2 8 18 16 20 67 10 Deaths of Hornsey Residents—continued  Under 1 1 to 2 2 to 4 5 to 14 15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and over Totals 15 Leukaemia, aleukaemia M . . . . . . . . 1 1 • 2 3 F . . . . . . . . . 1 . 1 16 Diabetes M . . . . . . . 1 1 2 . 4 9 F . . . . . . . . • 1 4 5 17 Vascular lesions of nervous system M . . . . . . . 2 5 16 24 47 138 F . . . . . . 1 5 11 18 56 91 18 Coronary disease, angina M . . . . . . 5 9 35 31 35 115 179 F . . . . . . • 2 7 24 31 64 19 Hypertension with heart disease M . . . . . . . 1 • 2 5 8 24 F . . . . . . . . . 6 10 16 20 Other heart diseases M . . . . . . . 2 2 15 26 45 144 F . . . . . . .3 3 13 78 99 21 Other circulatory diseases M . . . . . . . • 5 8 12 26 58 F . . . . . . . . 3 9 20 32 22 Influenza M . . . . . . . 1 1 . 1 2 2 F . . . . . . . . . 23 Pneumonia M . . . . . . . . 2 6 9 20 56 F . . . . . . . 1 4 10 19 36 24 Bronchitis M . . . . . . . 2 5 23 14 45 85 F . . . . . . . . 4 16 20 40 25 Other diseases of respiratory system M . . . . . . . . . . 1 1 5 F . . . . . . . 1 . . 3 4 11 Deaths of Hornsey Residents—continued  Under 1 1 to 2 2 to 4 5 to 14 15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and over Totals 26 Ulcer of stomach and duodenum M . . . . • . 1 2 4 3 . 10 14 F . • . . . . . • . 2 2 4 27 Gastritis, enteritis and diarrhoea M . . . . . . 1 . . 1 . 2 6 F . . . . . . . 1 . 3 4 28 Nephritis and nephrosis M . . . . . . . . 1 3 1 5 12 F . . . . 1 . . . 1 2 3 7 29 Hyperplasia of prostate M . . . . . . . . . 3 10 13 13 F . . . . . • . • . . . 30 Pregnancy, childbirth, abortion M . . . . . . . . . . . . 1 F • • . . . 1 .. . . . . 1 31 Congenital malformations M 5 . 1 . . • . 1 . . . 7 11 F 1 . . . • • 1 . • 1 . 4 32 Other defined and ill-defined diseases M 12 . • • . 1 . 4 5 10 13 45 96 F 3 . 1 1 . 1 2 2 6 17 18 51 33 Motor vehicle accidents M . . . . . 1 . . . • . 3 5 F . . • . . . . . . . 2 2 34 All other accidents M . . . . 1 . 1 . 1 . 6 9 27 F . 1 . . . 1 . . . . 16 18 35 Suicide M . . . . . 2 . 1 3 1 7 11 F • . . . . 1 . 2 . 1 . 4 M 21 1 2 1 5 6 13 34 96 | 153 190 522 F 4 3 1 2 3 7 14 30 76 1 164 326 630 Totals 25 4 3 3 8 13 27 64 172 | 317 516 1,152 12 N P, nO Deaths accurred from the follwing causes. INFANT DEATHS CAUSES BY AGE GROUPS AND SEXES Under 1 Day 1—6 Days 1 Week 2 Weeks 3 Weeks Total U nder 1 Month 1—2 Months 3—5 Months 6—8 Months 9—11 Months Totals Meningococcal infection M . . . . . . . . 1 . 1 1 F) . . . . . . . . . . . Pneumonia M . 2 . . . 2 . . . . 3 3 F . . . . . . . . . . . Congenital malformations M 3 . . . . 3 . . . . 5 6 F . 1 . . . 1 . . . . 1 Injury at birth M 4 . . . . 4 . . . . 4 5 F 1 . . . . 1 . . . . 1 Post-natal asphyxia and atelactasis M 2 1 1 . . 4 . . . . 4 4 F . . . . . . . . . . . Prematurity, immaturity M 2 . . . . 2 . . . . 2 4 F 1 1 . . . 2 . . . . 2 Other diseases of early infancy M 1 1 . . . 2 . . . . 2 2 F . . . . . . . . . . . M 12 4 1 . . 17 . 1 3 . 21 25 F 2 2 . . . 4 . . . . 4 TOTAL 14 6 1 . . 21 . 1 3 . 25 13 SANITARY CIRCUMSTANCES HOUSING AND HEALTH Housing in relation to health has been a major problem for many years and may be expected to grow even worse if existing properties are allowed to become more dilapidated and essential repairs continue to be neglected. The problem too of the "absentee landlord" must be faced and an effort made to deal with it on a national basis. Local authorities in the meantime are having to work with out-of-date legislation designed to meet conditions quite different from those applying today. In my last report I referred to some effects of difficult housing conditions on health; many instances of friction between tenants are being met by the Health Department. That more houses and flats are required is accepted, but it is also a fact that many units of accommodation are being allowed to deteriorate because rents are too low to cover the present maintenance costs. This, again, is a problem which cannot be solved at local level and the Health Department is much concerned with the low standard of housing in parts of the Borough and the difficulty of deciding what is the standard to be accepted as fit for habitation. In every district there are houses which, though structurally sound are without those amentities considered necessary by modern standards. These houses are however, reasonably fit for habitation and will form a large part of the available housing accommodation for some years to come. It should be possible to achieve the same standard of fitness in this type of property as the Minister has specified for a dwelling in respect of which financial assistance can be given for the conversion or improvement of a dwelling under the Housing Act, 1949. This standard is contained in the report of the Standards of Fitness for Habitation Sub-Committee of the Central Housing Advisory Committee and is as follows:— The dwelling must:— (i) be in all respects dry: (ii) be in a good state of repair: (iii) have each room properly lighted and ventilated: (iv) have an adequate supply of wholesome water laid on for all purposes inside the dwelling: (v) be provided with efficient and adequate means of supplying hot water for domestic purposes: (vi) have an internal or otherwise readily accessible water-closet : (vii) have a fixed bath, preferably in a separate room: (viii) be provided with a sink or sinks with suitable arrangements for the disposal of waste water: 15 (ix) be provided with facilities for domestic washing, including a a copper, preferably in a separate room: (x) have a proper drainage system: (xi) be provided with adequate points for artificial lighting in each room: (xii) be provided with adequate facilities for heating each habitable room: (xiii) have satisfactory facilities for preparing and cooking food: (xiv) have a well-ventilated larder or food store: (xv) have a proper provision for the storage of fuel: (xvi) have a satisfactory surfaced path to outbuildings and convenient access from a street to the back door. It is true this standard has been adopted only for a dwelling improved with assistance under the 1949 Act, and which has a life of at least 30 years but it is clearly desirable as conditions improve, this standard should be the criterion when deciding whether a house is fit or otherwise, in contemplating action under Section 9 of the Housing Act, 1936. The one per cent, sample tables of the 1951 Census revealed that 45 per cent, of all householders either share a fixed bath or are without one. The corresponding figure is 23 per cent, in the case of waterclosets and 17 per cent, in respect of piped water. In the case of piped water, cooking stove and water-closet, the householders sharing the arrangements with others are twice as numerous as those entirely without, but those entirely without a fixed bath are more than five times as numerous as those sharing. Thus it is clear that the housing problem is not only one of provision of new houses, but also the improvement of large numbers of substandard houses. CAMPSBOURNE CLEARANCE AREA The first stage which was commenced in October, 1949 is partly completed and of the 48 new flats in Brook Road, 24 are occupied and 24 are nearing completion, while 23 others in the area are in the course of construction. Thirty-six families have been re-housed from houses numbered 6 to 56 Boy ton Road which will be demolished during the next stage, and 26 families are still to be re-housed. Like similar houses in Campsbourne and Myddelton Roads these dark and damp basements in Boyton Road by reason of disrepair, sanitary defects and absence of essential conveniences form the greatest and most urgent problem from a health point of view. It is gratifying to know that the families from these houses, have the opportunity of 16 enjoying good housing conditions, a relief from the emotional stress due to overcrowding and with the added conveniences and amenities making possible a happier home life for the whole family. DEMOLITION AND CLOSING ORDERS The Committee considered making a Demolition Order in respect of Lauralhurst Cottage, St. James's Lane but the owner agreed to demolish the property if the Council would re-house the tenants. This was done. The Closing Order served on 29th December, 1950 on two basement rooms at 26 Myddelton Road was determined on 10th September, 1952 by the Health Committee as the Council's Regulations under Section 12 of the Housing Act, 1936 had been complied with. 17 Closing Orders Property Part Council Order Action affected resolution made taken 15 Hampstead Lane Two rooms 18th Nov. 20th Nov. Rooms closed and kitchen in basement PURE AIR One hundred years of Public Health effort has produced in England a people who demand pure water to drink as a fundamental right; the new Elizabethan era should set out to evolve a generation who will demand pure air to breathe. The fog in December provided convincing evidence of the state of pollution of our atmosphere due to the products of the unsatisfactory combustion of coal. The fog affected all ages; children developed coughs, healthy adults suffered from varying degrees of laryngitis, elderly chronic bronchitics suffered weeks of invalidism and the death rate in elderly people was double the normal rate for the two-week period. The graph on page 22 shows how the numbers of deaths for the period compares with the average numbers of deaths for the corresponding weeks of the preceding three years. Smoke comes from many sources—the ordinary householder produces most, and the Nationalisation of some of the offending industries (Railways, Gas and Electricity) has not so far shown an example in smoke prevention due to economic reasons. ATMOSPHERIC POLLUTION The pollution of the atmosphere in a district normally results from the combustion of coal and its derived fuels. Coal has been used in this country as a source of heat for at least a thousand years, displacing wood which became scarce and expensive. The pollution of the London atmosphere from coal smoke has been a constant cause of complaint and legislation against it dates back to the reign of Edward I. With the coming of the industrial revolution and the consequent increased consumption of coal, the problem became more acute. In 1890, Sir John Simon, Chief Medical Officer, Local Government Board, wrote:— "See with what apparent indifference our nineteenth century England acquiesces in a daily increasing sacrifice of daylight to dirt. There are immense masses of our population—the inhabitants, for instance, of London and of many chief manufacturing towns—who endure without revolt or struggle the extremities of general "Smoke Nuisance": not only condoning the fact that the nuisance is of painful injury to an appreciable number of persons, and in certain states of the weather kills many of them: but further accepting, as if in obedience to some natural law, that their common life shall in great part be excluded from the pure light of day by an ignoble pall of unconsumed soot: and hardly murmuring, in their self-imposed eclipse, that their persons and clothing and domestic furniture are under the incessant grime of a nuisance which is essentially removable." 18 It has been estimated that over 8 million tons of atmospheric pollution are produced each year in this country and a large part of this pollution comes from the domestic fire. Impurity in the atmosphere can take the form of solid or liquid particles which may be so large that they settle rapidly, or so small that they remain suspended for a very long time. The nature of the impurity is determined largely by the prevailing type of industry in the neighbourhood. The products of combustion which give rise to pollution of the atmosphere may be broadly divided into three categories:— (1) Ash and Grit. Ash consists of mineral matter from the fuel and grit consists of particles of combustible material in the form of burnt or partly burnt fuel. Most particles of ash and grit are large enough to be deposited fairly rapidly near to their source of origin. (2) Smoke is the term normally applied to the visible products of imperfect combustion. It contains a high proportion of carbon and liquid tarry matter. These particles remain suspended in the air for a long time and may travel considerable distances before they are removed. It has been estimated that the average time for which a smoke particle remains in suspension is one or two days. (3) Gases, e.g. hydrocarbons, carbon dioxide, carbon monoxide, oxides of sulphur. By far the most important of these is sulphur dioxide. When fuel is burnt, only a small amount of the sulphur remains with the ashes, and the rest is released as sulphur dioxide in the flue gases. Of these a small amount is usually retained in the flues and the rest is discharged into the atmosphere. Atmospheric sulphur dioxide is the agent mainly responsible for the corrosion of metals and the decay of stonework and building materials. It will thus be seen that the pollution of the atmosphere from the use of coal and its products is serious. It involves damage to structures, fabrics and vegetation and is detrimental to health. A smoky grimy atmosphere cuts out sunlight and deposits dirt. In order to measure the deposited atmospheric pollution the Borough Council authorised the setting up of three deposit gauges in the Borough in February, 1952. These are situated on the roof of the Town Hall, the roof of the Church of Christ, Wightman Road and the roof of Mather's factory at the eastern end of Frobisher Road. The gauges are permanently in postion and the sites were selected in consultation with the Fuel Research Station, Greenwich. On the first day of each month, the solid and liquid pollution, including rain, which falls within the glass collecting bowl of the gauge is collected and sent for measurement and analysis. The following table shows the results of the analyses of deposited matter from February to December, 1952. 19 ATMOSPHERIC POLLUTION—SUMMARY OF REPORTS FOR THE YEAR 20 (a) Roof of Town Hall. (b) Church of Christ—Wightman Road, (c) Mather's Factory—Frobisher Road. 1952 Deposit in Tons per Square Mile Rainfall in inches Total water-insoluble matter Ash Total water-soluble matter Total solids (a) (b) (e) (a) (6) (c) (a) (b) (c) (a) (6) (c) (a) (b) (c) February 0.73 0.71 0.68 9.69 17.04 9.64 6.18 11.19 5.87 4.48 5.79 5.60 14.17 22.83 15.24 March 2.72 2.52 2.52 14.46 33.44 12.56 9.42 25.56 7.79 7.98 12.96 9.28 22.44 46.40 21.84 April 1.30 1.21 1.17 12.66 17.69 11.43 8.49 11.89 7.14 5.30 7.49 5.50 17.96 25.18 16.93 May 0.87 0.84 0.88 10.63 20.14 9.21 7.26 14.23 5.93 4.09 5.56 4.01 14.72 25.70 13.22 June 1.55 1.48 1.64 10.73 17.34 7.72 7.54 12.50 4.71 4.06 5.07 3.02 14.79 22.41 10.74 July 0.60 0.47 0.51 11.86 18.31 8.05 9.06 12.92 4.96 2.68 3.93 2.45 14.54 22.24 10.50 August 2.40 2.34 2.36 11.19 22.15 7.39 8.05 16.23 4.49 5.01 6.09 4.31 16.20 28.24 11.70 September 3.36 3.30 3.44 9.52 28.01 8.42 6.64 22.31 5.24 6.81 6.97 5.04 16.33 34.98 13. 46 October 2.48 2.43 2.23 10.47 34.49 9.48 7.30 28.60 6.13 8.80 11.26 9.51 19.27 45.75 18.99 November 3.64 3.99 3.75 9.10 76.17 11.55 6.25 68.94 7.41 10.32 15.18 12.17 19.42 91.35 23.72 December 2.15 2.12 2.06 10.18 40.28 9.84 6.58 33.77 6.03 7.85 11.58 8.48 18.03 51.86 18.32 ATMOSPHERIC POLLUTION 21 22 WATER SUPPLY I am indebted to Lt.-Col. E. F. W. Mackenzie, Director of Water Examination of the Metropolitan Water Board, for the following information. The water supply for Hornsey has been satisfactory both in quality and quantity during the year. It is provided by the Metropolitan Water Board from two sources:— (a) River Thames water stored in Littleton and Walton reservoirs and treated at the Board's filtration works at Kempton Park, Hampton and Walton. (b) Water from the River Lea treated at the Board's filtration works at Stoke Newington and Hornsey. Samples are collected on five days in every week, or more often if required, at each stage of the purification process and tests include physical, chemical and mocro-biological examination. The water supplied to this area is not plumbo-solvent. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bacteriologically to ensure that its quality is up to that normally supplied. The water supply is in all cases direct to dwelling houses ; none is supplied by means of a stand pipe. Chemical Examination 245 samples of water were taken for chemical examination from the Kempton Park, Hampton and Walton Works, 243 from Stoke Newington and 240 from the Hornsey Works. All were found to be satisfactory. Bacteriological Results Filtration Works No. of Samples No. of microbes per ml. Colonies counted on agar after 20-24 hrs., at 37°C. Bad. coli test Percentage of samples negative to Bact. coli in 100 ml. Bact. coli per 100 ml. Kempton Park 846 38.3 99.9 0.002 Hampton Works 786 7.0 99.9 0.004 Walton Works 258 15.9 99.6 0.008 Stoke Newington 257 27.3 100.0 — Hornsey Works 257 17.4 100.0 — 23 POLLUTION OF THE MOSELLE The area drained by the Moselle and its tributaries includes part of Muswell Hill, lower Highgate, Central Hornsey, part of Crouch End and the Campsbourne. It eventually flows into the River Lea via Wood Green and Tottenham. Almost all the properties in this drainage area have two systems of drains—soil and surface-water. It is the surface-water drains which discharge into the Moselle. These should carry only rain-water but investigation has disclosed that in many houses waste water and soil fittings have been connected to the surface-water drains. Other sources of pollution, some from industrial premises, are also affecting the purity of the effluent. The situation gradually deteriorated and in July, 1947, the Lee Conservancy Catchment Board served a notice on the Borough Council to abate the pollution. As a result of the notice a complete check on sewers throughout the entire Moselle drainage area was carried out. Each check was followed by inspections of properties from which it was suspected that pollution was occurring. The inspections involved examination of the front inspection chambers where it was often found that the soil drain was choked and the sewage was leaking into the surface-water system. Sampling of the dry weather flow of the Moselle clearly indicated that pollution was not restricted to any one part of the area. After further consideration by the Council it was decided that the only way to solve the problem was to check and, if necessary, test or trace the drains of every property draining into the Moselle. This work was commenced by the permanent sanitary inspectors, but as they could only devote part of their time to it, two additional temporary sanitary inspectors were appointed in January, 1951. They were engaged full-time with the sewer flushers in checking and testing all drains and fittings. After eight months the two temporary inspectors left to take up permanent appointments and they were replaced in October, 1951, by one temporary inspector. The investigation continued throughout 1952 and into the first few months of 1953. Altogether 8,297 properties have been inspected. Sources of pollution found are shown in the following table:— Discharging into surface-water drain: Sinks 552 Baths 101 Lavatory basins 201 Water-closets 41 895 Choked soil drains overflowing into surface water drains 84 Pollution from gullies connected to surface water drains 28 24 In addition, 2,503 re-inspections were made and 635 notices served. The number of premises found to be satisfactory was 7,662. The investigation has now been completed and with the exception of the drainage from the Crouch End Playing Fields the necessary action to abate the pollution has been taken. The figures disclose that nearly 8 per cent, of the properties in the Moselle drainage area were found to be causing pollution. For the time being the problem can be considered as solved, but as long as it is the practice to construct drains in such a way that both soil and surface-water systems pass through the same manhole so will pollution be likely to occur when the soil drain becomes obstructed thus causing sewage to overflow into the surface-water drain. Considerable pollution is also caused by the fitting of sinks, baths, lavatory basins, etc. and taking the waste pipes from these fittings into the nearest drain inlet, which is often the surface-water drain. Pollution is still occurring from a number of sanitary fittings on the playing fields. This matter is under consideration but it is unfortunate that the necessary drainage works could not have been carried out before the summer season started. 25 WORKPLACES NOT COVERED BY FACTORIES ACTS: PROPOSED LEGISLATION re SHOPS, OFFICES, ETC. Correspondence has recently appeared in the newspapers, drawing attention to the need to expedite legislation proposed by the Gowers Committee in connection with the health of office workers. Some years ago, the Gowers Committee was set up with the following terms of reference:— (i) to enquire into the provisions of the Shops Acts relating to closing hours (general and local) and to report as soon as possible whether any alterations are desirable. (ii) to enquire into and make recommendations as to extending, strengthening or modifying:— the statutory provisions relating to the health, welfare and safety of employed persons at places of employment other than those regulated under the Factories or Mines and Quarries Act, and (iii) to enquire into and make recommendations as to the machinery for enforcing statutory provisions within the scope of (i) and (ii) above. An interim report relating to closing hours of shops was submitted in 1947, followed two years later by a report on Health, Welfare and Safety in Non-Industrial Employment. This report not only suggested extending existing controls over shops, but also the inclusion of similar controls for other non-industrial premises. The Home Office has recently forwarded draft proposals for legislation based on the recommendations of the Gowers Committee to organisations which gave evidence before the committee. The proposals are that specific provisions should apply initially to shops, offices, and catering establishments, theatres, cinemas and music halls, railways and certain transport premises, agriculture and forestry, and dental mechanics' workrooms. Power to extend the legislation, by special regulations, to other classes of premises will be given. It is proposed to make it the duty of every local authority to enforce within their districts the provisions of this part of the legislation, and for this purpose "local authority means . . . (elsewhere than in the County of London) as respects a borough, urban district or rural district, the council of the borough or district." The work of local authority health departments will obviously be increased. The suggested legislation places a duty upon them to appoint suitable Shops Act Inspectors, and gives the Secretary of State power to make regulations prescribing qualifications to be held by inspectors. 26 There is also the suggestion of an annual report to be made by each authority and submitted to the Secretary of State, and this suggests that reasonable supervision will be maintained by the central government to ensure that local authorities are carrying out their functions satisfactorily. The proposals are far reaching and merit very careful study. Legislation of this nature is urgently required, but there may be some further delay while interested parties consider the suggestions. INSPECTION OF SHOPS 1,944 visits were paid to shops and, apart from a number of minor infringements, which were dealt with, the provisions of the Shops Acts have been well observed. Sixty-four written notices were served and as a result the following defects were remedied. Lighting provided 37 Heating provided 6 Sanitary Accommodation provided 35 Sanitary Accommodation labelled 44 Washing facilities provided 83 Seats for shop assistants 6 Number of shops cleansed 81 Number of shops dealt with 171 RODENT CONTROL Following is a summary of the work carried out during 1952:— Number of properties inspected 468 Number found to be infested with rats (a) Major (i.e. more than 20 rats) 5 (b) Minor 175 Number treated by the Rodent Operator 180 Number infested with mice 68 Number treated by Rodent Operator 24 Number given advice 44 27 LICENSING OF PET SHOPS On 1st April, the Pet Animals Act, 1951, came into force. It provided that no person may keep a pet shop unless he obtains a licence from the local authority which was empowered to specify in the licence such conditions as appear necessary for securing the objects of the Act. The local authority was authorised to make arrangements for inspection of pet shops and in Hornsey the veterinary inspector, and sanitary inspectors carry out this duty. Among other restrictions it is now illegal to sell an animal as a pet to a child under the age of 12 years. In Hornsey eight premises were registered as pet shops as follows :— Dogs, cats, kittens, etc 1 Tropical fish 4 Birds and fish 2 Birds and small mammals 1 One registration for tropical fish has since been cancelled by the applicant. The conditions inserted in the licence issued to shop keepers are as follows:— Conditions for Inserting in Licences Issued under The Pet Animals Act, 1951 as Approved by The Law Committee of the A.M.C. 1. No animal shall be displayed in a cage, hutch, box or other receptacle in such position as to expose it to interference or annoyance by persons or animals. 2. Animals shall at all times be kept in accommodation suitable as respects size, temperature, lighting, ventilation and cleanliness. 3. Animals shall be adequately supplied with suitable food and drink and (so far as necessary) visited at suitable intervals. 4. Animals and stock shall not be placed or kept in or outside the shop so as to render ingress or egress difficult in case of fire or other emergency. 6. Licensee shall ensure that a responsible person shall at all times be in or within a reasonable distance from the premises for the purpose of giving warning and taking other necessary steps in the event of fire or other emergency. In the case of premises which are lock-up, outside business hours, the licensee shall appoint a responsible person residing within a reasonable distance to the premises to have custody of the key. The name and address of such person shall be displayed in legible characters on the front door, or windows, of the premises. A supply of water and sand and/or an efficient fire extinguisher must always be available on the premises. 6. No animal which is suffering from or could reasonably be suspected of having come into contact with any other animals suffering from any infectious disease shall be brought or kept on the premises unless it is properly isolated from the other animals therein. 7. Animals shall not be handed to customers in unsuitable containers. 8. No mamal shall be sold unweaned, or if weaned, at an age at which it should not have been weaned. 9. Where animals are kept in cages, hutches, boxes or other receptacles placed on top of other cages, hutches, boxes or other receptacles, effective means shall be provided for preventing water, food or other droppings falling on to or contaminating the animals or other surroundings which are underneath. 28 HOUSING INSPECTIONS 1.—Inspection of Dwelling houses during the year:— (a) Total number of dwelling-houses inspected for housing defects under Public Health or Housing Acts 1,282 (b) Inspections, made for the purpose 1,402 2.—Housing Act, 1936: (a) Houses demolished as a result of formal procedure Section 113 (b) Pafts of buildings closed (Section 12) 2 (c) Houses made fit as a result of informal notices preliminary to formal procedure under Sections 9 & 12 2 3.—Public Health Acts: Houses in which defects were remedied by owner after service of formal notice 158 BYELAWS relating to houses intended or used for occupation by the working classes and let in lodgings or occupied by members of more than one family. Four houses have been dealt with under these Byelaws during the year and the following work carried out :— 4 (b) Water Supply 3 5 (6) Means of carrying off waste water 3 NOTICES The Notices served during the year were as follows:— Verbal Preliminary Statutory Public Health and Housing Acts 76 935 175 Housing Byelaws — 3 1 Shops Acts 33 64 — Food and Drugs Act — 124 — Factories Act 8 18 5 Pet Animals Act, 1951 — 1 — Prevention of Damage by Pests Act, 1949 — 1 — 117 1,146 181 29 FACTORIES ACT, 1937 The following tables show the work carried out by the Sanitary Inspector under this Act :— 1. Inspections of Factories Premises Number of Inspections Written Notices Prosecutions Factories with Mechanical Power 348 5 NIL Factories without Mechanical Power 74 — TOTALS 422 5 NIL 2. Detects Found Particulars No. of defects Referred to H.M. Inspector Number of defects in respect of which Prosecutions were instituted. Found Remedied Want of Cleanliness 29 29 Overcrowding — — Unreasonable Temperature 5 5 Inadequate ventilation 6 6 Ineffective drainage of floors — — NIL NIL Sanitary Conviences (a) insufficient 24 24 (f>) unsuitable or defective 58 58 (c) not separate for sexes — — Other offences — — TOTALS 122 122 NIL NIL There are 221 Outworkers on the register engaged in the following occupations:— Making, altering etc. of wearing apparel 169 Making-up, ornamenting etc. of household linen 5 Cabinet and furniture making 1 Making of iron and steel cables and chains 2 Making and repairing of umbrellas 1 Making of artificial flowers 18 Making of paper bags 1 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 16 Making of brushes 1 Making of stuffed toys 2 Making or filling of Christmas crackers, Christmas stockings, etc 4 The weaving of any textile fabric 1 232 visits were paid to outworkers' premises during the year. 30 INSPECTIONS BY SANITARY INSPECTORS Is/ Inspections Re-inspections Food Food Premises (See table on next page) 725 370 Registration of Hawkers 20 — Milk Sampling 35 — Ice Cream Sampling 36 — Infectious Diseases Notifiable Infectious Diseases 311 41 Food Poisoning 11 5 Sanitary Inspections Complaints 1,732 5,368 Drainage 289 643 Water Tests applied 52 — Smoke and Chemical Tests 108 — Rodent Control 251 171 Survey (Permitted numbers) 121 3 Overcrowding conditions 5 9 Building Licences 15 — Factories 422 — Outworkers 226 6 Renewal of Music and Dancing Licences 15 2 Moselle Pollution 2,558 1,216 Smoke observations 68 24 Stables and Urinals 8 2 Verminous conditions 14 4 Pests 57 15 Under Rag, Flock, etc., Act, 1951 5 — Other reasons 435 20 Street Traders 3 — Pet Animals Act, 1951 8 59 Massage and Special Treatment 27 — Shops Inspections General Inspections 1,527 417 Sunday Trading 402 — Others Petroleum Stores 133 47 Moselle Sewer Samples 25 — Drainage Repairs and Reconstructions 30 245 9,674 8,667 TOTAL VISITS 18,341 31 SUMMARY OF SANITARY IMPROVEMENTS EFFECTED Drainage Number of houses and premises redrained 15 Repairs or amendments to existing drains 212 Drains or gullies unstopped or cleansed 224 Manholes provided or repaired 118 Intercepting traps fixed 25 Soil and ventilation pipes repaired or renewed 44 Water-Closet and Sanitary Fittings Water-closet buildings provided or repaired 20 Water-closet pans provided or renewed 73 Water-closets unstopped, cleansed or repaired 29 Flushing cisterns provided or repaired 39 New sinks provided 91 New lavatory basins provided 29 Waste pipe trapped, repaired or unstopped 277 Baths provided or made usable 7 Urinals cleansed 12 General Roofs repaired 320 Rain-water gutters, renewed or repaired 126 Rain-water pipes provided or repaired 66 Dampness remedied 128 Damp-proof courses provided 8 Yard paving provided or repaired 68 Rooms cleansed 567 Rooms disinfested of vermin 2 Walls and ceilings repaired 160 Floors repaired 158 Windows, doors, skylights, sashcords and fittings repaired 212 Window-sills repaired 43 Water cisterns repaired, cleansed or covered 11 Water supply pipes repaired 23 Stoves, Ranges, Coppers renewed or repaired 52 Flues and Chimneys repaired 20 Accumulation of Refuse removed 10 Dustbins provided 68 Food Stores provided 20 Miscellaneous items 61 32 LEGAL PROCEEDINGS UNDER PUBLIC HEALTH ACT, 1936 Date of Hearing Premises Section of Act Defects Result of Proceedings 16th Jan. and 23rd Jan. and 2nd Feb. 67 Lothair Road, N.4 92/93 Back addition roof and general defects. Adjourned 7 days. Adjourned 10 days. Summons withdrawn on payment of £6 6s. costs. Work completed. 16th Jan. 136 Stroud Green Road, N.4 92/93 Dampness and general defects. Adjourned 28 days. Withdrawn later on completion of work. 16th Jan. 43 Uplands Road, N.8 92/93 Roofs. Adjourned sine die. 16th Jan. 139 Nelson Road, N.8 92/93 Roofs and dampness. Court Order for execution of work within 28 days and fined £3. 3s. costs. Work completed. 16th Jan. 19 Mayfleld Road, N.8 92/93 Defective ceiling plaster. Court Order for execution of work within 14 days. Work completed. 19th March 15 Hampstead Lane, N.6 92/93 Dampness. Adjourned sine die. 19th March 84 Inderwick Road, N.8 92/93 Defective roof. Summons withdrawn. Work completed. 2nd April 35 Duckett Road, N.8 92/93 Roofs, wall and ceiling plaster. Court Order for execution of work within 14 days and £2 2s. costs. Work completed. 2nd April and 16th April 25 Northwood Road, N.6 92/93 Defective roof. Adjourned 14 days. Subsequently withdrawn on completion of work. 2nd April 35 Middle Lane, N.8 92/93 Defective roof. Summons withdrawn and £1. Is. costs.Work completed. 33 34 LEGAL PROCEEDINGS UNDER PUBLIC HEALTH ACT, 1936—continued Date of Hearing Premises Section of Act Defects Result of Proceedings 14th May and 21st May 72 Campsbourne Road, N.8 92/93 & 39 Defective roof, dampness, general defects and defective eaves gutter. Adjourned 7 days. Adjourned 7 days. "Withdrawn later on completion of work. 14th May 41 Middle Lane, N.8 92/93 Defective roof. Summons withdrawn. Work completed. 14th May 39 Haringey Park, N.8 39 Untrapped sink. Summons withdrawn. Wprk completed. 14th May 55 Florence Road, N.4 92/93 General defects. Summons withdrawn. Work completed. 14th May 67 Victoria Road, N.4 39 Defective rain water pipe. Summons withdrawn. Work completed. 21 May and 28th May 10 Christchurch Road, N.8 92/93 Dampness. Adjourned 7 days. Court Order for execution of work within 28 days and fined £5. and £5. 5s. costs. 7th July and 1 Oct. and 15th Oct. and 5th Nov. 23 Claremont Road, N.6 92/93 Defective roof and dampness. Court Order for execution of work within 21 days and £1 Is. costs. Adjourned 14 days. Court Order not complied with. Adjourned 21 days. Work completed. Discharged on payment of £5. 5s. costs. 14th July 49 Elder Avenue, N.8 39 Improperly discharging waste pipe. Court Order for execution of work within 14 days. Fined £1 with daily penalty of 40/— after 28th July and £4. 4s. costs. Work completed. 14th July 39 Haringey Park, N.8 92/93 Dampness and general defects. Adjourned sine die. Work completed. 35 LEGAL PROCEEDINGS UNDER PUBLIC HEALTH ACT, 1936—continued Date of Hearing Premises Section of Act Defects Result of Proceedings 6th Aug. and 27th Aug. 1 Winchester Road, N.6 92/93 General defects. Adjourned 14 days. Court Order for execution of work within 28 days and £3. 3s. costs. Work completed. 1st Oct. and 29th Oct. 64 Campsbourne Road, N.8 92/93 Obstructed main flue. Adjourned 28 days. Summons withdrawn. Work completed. 1st Oct. and 29th Oct. 66 Campsbourne Road, N.8 92/93 Obstructed main flue. Adjourned 28 days. Summons withdrawn. Work completed. LEGAL PROCEEDINGS UNDER THE SHOPS ACT, 1950—Section 2 Date of Hearing Premises Offence Result of Proceedings 19th March 122 Tottenham Lane, N.8 Being open after general closing hours. Fined 10/- FOOD INSPECTION OF FOOD PREMISES The inspection of food premises in the Borough has continued and I am pleased to report that on the whole there has been further improvement in the general standard of hygiene, due in part to the efforts of this department but probably in greater measure to the growing public discrimination in favour of cleaner shops and cleaner handling of food. Work carried out by the owners or occupiers of food premises as a result of either verbal or written request from this department come under the following headings:— (1) Repairs or redecorations required to make the premises comply with the provisions of Section 13 of the Food and Drugs Act 1938. (2) The improvement of premises and the provision of equipment to ensure the clean handling of food, the protection of food against aerial contamination and the preservation of food in a fresh condition and so stored as to prevent development of organisms of decomposition and contamination. On the question of the keeping of food in the freshest possible condition while stored or displayed in the shop, it might be appropriate to point out that existing legislation does not require that a grocer, for instance, should provide a refrigerator for the storage of butter, ham, cooked meats, or other perishable commodities. In spite of this omission most grocers in this Borough have agreed, upon request, that such a fitting is advisable and have installed one. The protection of fish, both wet and dry displayed for sale in fish shops continues to be a problem in that legislation fails to require the provision of glass fronting to this type of shop. Indeed the National Federation of Fishmongers and Poulterers recently cast further doubt on the hygienic efficiency of glass fronting so that fish intended for human consumption continues in many cases to be subjected to the risk of contamination by dust and flies and the area near the shop has the doubtful enjoyment of the odour of fish. In one shop in the Borough where a glass front has been provided it has been noticed that the temperature of the shop can be more effectively controlled, that there is no dust contamination and that flies are rarely seen in the premises. In food shops generally further progress has been made in the provision of sinks, hot and cold water supplies, adequate cloakroom space and other necessary measures required by Section 13 of the Food and Drugs Act, 1938 for the use of food handlers and to minimise the risk of food contamination. 37 LEGAL PROCEEDINGS Under Sections 3 and 9 of the Food and Drugs Act, 1938 Date of Hearing Offence Verdict 9th January Piece of bandage and lint embedded in a loaf of bread Fined £7. 5s. with £4.4s. costs 9th April Skin and hair of a mouse embedded in a loaf of bread Fined £10 with £5. 5s costs 30th April Contamination of flour by animal excreta Fined £10 with £5 costs 9th July Wood splinter and cement embedded in loaf of bread Fined £10 with £5. 5s. costs 18th November Dirty milk bottles (Three counts) Case dismissed and £5. 5s. costs awarded against the Council on each of the three counts. MILK SUPPLY The production and processing of milk continues to be a primary responsibility of the Ministry of Agriculture and Fisheries but the local authority is responsible for the inspection of all dairies used for the distribution of milk. In this Borough there are no pasteurisation plants and no milk is bottled. The Milk (Special Designations) (Specified Areas) Order, 1951 came into operation on 1st October, 1951. This Order makes compulsory the use of special designations for retail sales of milk in certain areas specified in the Schedule of the Order and the whole of Middlesex is one of the areas specified. Six dairy premises were registered during the year. Licences for the sale of special designated milk were granted as follows:— New Licences Renewals Dealers Supplementary Dealers Supplementary Pasteurised 1 — 28 10 Tuberculin Tested — — 25 10 Sterilised 5 — 40 11 Accredited — — — — On 1st October, 1954, the special designation "accredited" will cease to be used. Thirty-five samples of milk sold under special designations were taken in course of delivery or from shops and submitted for bacteriological examination. All were found to be satisfactory. The dirty milk bottle has been responsible for a number of complaints to the Department, and although efforts have been made to place the 38 responsibility for this matter on the company at whose plant the dirty milk bottles were used, these efforts have, so far, failed owing to the absence of sufficient proof of the place of the alleged offences. Milk bottlers are required to mark on the bottle cap the address of the bottling plant only in the case of the special designated milk sold as "Tuberculin Tested." Amendment of the Milk and Dairies Regulations to require this information for all "Designated" milks would enable more successful measures to be taken by the Local Authority to ensure the use of clean bottles. ICE CREAM The popularity of this commodity continues. There are now 167 premises in the Borough registered for the sale, storage or manufacture of ice cream. The introduction of the Ice Cream (Heat Treatment) Regulations in 1947, which require the pasteurisation of all ice cream mix, has resulted in a marked improvement in the standards of hygiene in both manufacture and distribution. During May the Ice Cream (Heat Treatment) Amendment Regulations, 1952 came into operation. This Amendment permits the use of high temperature short time (H.T.S.T.) method of pasteurisation for the treatment of ice cream mixes at a temperature of not less than 175° F. for at least 15 seconds. The enforcement of the provisions of the Food and Drugs Act as to registration and general hygienic requirements have called for regular and frequent inspections of premises. Thirty-six samples of ice cream were taken during the year and submitted for bacteriological examination. The results were as follows: Grade 1 Grade 2 Grade 3 Grade 4 29 6 1 — BAKEHOUSES The three underground bakehouses in the Borough continue to be in use, as they were certified in September, 1949 as suitable for that purpose for a further period of five years. They are inspected frequently to see that suitable hygienic conditions are maintained. There are twelve other bakehouses in the borough. SLAUGHTERHOUSES The Live Stock (Restriction of Slaughtering) Order, 1940, continued in force and no slaughtering was carried out during the year. No licences to slaughter were issued. 39 REGISTRATION OF HAWKERS OF FOOD AND THEIR STORAGE PREMISES Five Hawkers were registered under the Middlesex County Council Act, 1950. REGISTRATION OF PREMISES FOR THE MANUFACTURE OF PRESERVED FOODS No registrations were effected under the provisions of Section 14 of the Food and Drugs Act, 1938, for the pickling of meat. The total number of registered premises in the borough is 58. FOOD PREMISES Inspection of Food Premises were made during the year as follows:— 1 St Insp. ReInsp. 1st Insp. ReInsp. Bakehouses 101 105 Grocers' Shops 217 63 Butchers' Shops 67 19 Horse Flesh Butchers 8 2 Cooked Meat Shops 6 2 Ice Cream Premises 29 2 Confectioners 39 19 Milkshops 14 - Fish Shops 42 20 Public Houses 148 81 Greengrocers' Shops 30 17 Restaurants, Cafes, etc. 124 40 TOTAL INSPECTIONS MADE 1,095 The following is a list of food condemned as unfit for human c sumption. Wherever possible this was disposed of as salvag :— Cwt. lbs. Cwts. lbs. Canned Vegetables 5 27 Sugar - 18 Canned Fruit and Fruit Juice 20 34 Flour — 10 Canned Meat 23 31 Mincemeat — 9 Canned Fish 1 28 Xmas Pudding ... — 12 Canned Soup 1 54 Potato Powder 7 21 Canned Jam and Marmalade 1 36 Pudding Powder — 16 Dried Vegetables 4 6 Blancmange and Junket Powder — 7 Dried Fruit 2 54 Sandwich and Chocolate Spread — 28 Dried Milk — 20 Pickles and Various Sauces — 27 Meat and Bacon 17 65 Confectionery and Biscuits — 87 Poultry — 11 Cereals 1 93 Rabbits 1 12 Coffee — 2 Fish — 97 Sweets — 79 Cheese — 38 Cucumbers — 51 Fats ... — 79 Canned Milk 107 pints TOTAL FOOD CONDEMNED 92 cwts., 44 lbs., and 107 pints of Milk. 268 visits were made to food premises in connection with condemnation. 40 FOOD SAMPLING I have received the following information from Mr. J. A. O'Keefe, Chief Officer of Public Control of the Middlesex County Council whose Department is responsible for food sampling in the Borough. 41 Food and Drugs Acts, 1938-1950 List of Samples Procured in the Borough of Hornsey during the year 1952. Total samples Articles procured Unsatisfactory Milk (Various) 122 9 Arrowroot 8 — Baking Powder 1 Cakes (Various) 33 Carraway Seed 1 Coffee 1 — Cooked Meat 9 — Cornflour 1 Drugs (Various) 10 — Fish (Various)12 — Fish Paste 3 — Flour 2- Full Cream Milk 1 - Fruit Squash 2 — Gelatine 1 — Honey 1 — Jam 1 — Marmalade 1 — Meat Pie 4 — Orange Curd 1 — Pastry-Mix 1 — Pepper Substitute 1 — Raisin Wine (Non-Alcoholic) 1 — Sausages (Various) 32 — Sausage Roll 3 — Soups (Various) 4 — Spirits (Various) 16 — Suet Sweets 1 — Table Jellies 4 1 — Victoria Plums (Canned) 2 — Vinegar 20 9 Yoghurt 1 — Total 302 20 With regard to the 20 unsatisfactory samples, the 9 samples of milk include 2 samples which were deficient in solids-not-fat. They were natural deficiencies however, and no action was taken other than to point out the matter to the firm in question. The other 7 samples were all cases of hot milk which contained added water and in 5 cases the sellers were prosecuted. A total of £10 fines and 10 guineas costs were awarded. The matter of the unsatisfactory sweets sample was one of misleading description in that it was a case of a cake decoration which, because of low sugar content, was misdescribed "sugar strands." In view of the particular circumstances in this case no further action than warning to the retailer was taken. One table jelly failed the setting test by the appropriate Standards Order and in this case a warning was sent to the firm. The 9 vinegar cases were all of passing-off non-brewed condiment as vinegar. There was one prosecution and warnings were given in the other instances. 42 INFECTIOUS DISEASES The year 1952 has been free from any outbreaks of serious epidemic disease. Measles, whooping-cough, poliomyelitis, dysentery, acute pneumonia, food poisoning, puerperal pyrexia, all had a lower incidence than in 1951. Scarlet fever and erysipelas and paratyphoid fever (2 cases) were the only infectious diseases which showed a slight increase on the previous year's figures. Single cases of typhoid and meningococcal infection occurred. Of the two poliomyelitis cases only one suffered residual paralysis. No case of diphtheria occurred. Although there has been a slight increase in notification of scarlet fever cases during 1952, the disease has been very mild and complications few. With advances in therapy the complications of this disease are seldom serious. House disinfection by fumigation and sealing of rooms, hitherto obligatory, is not now generally carried out unless requested by the patient or his doctor. The introduction of the combined whooping-cough and diphtheria immunisation during 1952 means that a baby aged six months can now be given protection in three injections instead of five or six. This new scheme is very popular with the mothers and an increase is expected in the percentage of immunised children during 1953. Thirteen cases of food poisoning were notified during the year and ten were confirmed. Five were due to salmonella typhi-murium, one to salmonella enteriditis and one to salmonella montevideo. In three cases the cause was unknown. Five persons were admitted to hospital one of whom died on the day of admission from an infection of salmonella montevideo. DIPHTHERIA IMMUNISATION Immunisation is carried out by most general practitioners in the borough and in addition regular sessions are held at the welfare centres. The immunisation of children attending schools and day nurseries is also encouraged and special arrangements are made from time to time. During the year, 1,115 children under 15 years of age were immunised for the first time and 852 received "booster" injections generally on school entrance. By the end of the year 9,722 Hornsey children under the age of 15 years had received a course of immunisation at some time during their lives but this figure is little more than 50 per cent, of the child population and improvement is still desirable. Again there was no case of diphtheria in Hornsey during the year. Three persons were admitted to hospital but after observation were found to be suffering from tonsillitis. It is now eleven years since a Hornsey resident died from diphtheria and during that time the numbers of deaths in England and Wales have decreased steadily from 2,641 in 1941 to 31 in 1952. During that time the lives of some 10,000 children have been saved representing the 43 sible saving of over ten million pounds in the cost of hospital treatment. If one adds to this the saving in suffering and anxiety the incalculable gain to the community resulting from the national immunisation campaign can be appreciated. Saving in life and suffering cannot be shown in terms of pounds, shillings and pence and thus, preventive health work where marked results cannot be obtained rapidly, is so often neglected by comparison with the curative services. I must again emphasise the need for maintaining a sufficiently high proportion of immunised children; and that the general public must be constantly reminded of this. Diphtheria is a disease which still kills and any marked reduction in the number of immunised children constitutes a danger to the community from this cause. LABORATORY SERVICES The Laboratory Services are directed by the Medical Research Council on behalf of the Ministry of Health, Pathological specimens are sent for examination to the Central Public Health Laboratory at Colindale and the Branch Laboratory at Coppetts Wood Hospital, Hornsey. The Public Health Department is a collection centre for specimens submitted by general practitioners and local authorities and supplies of containers are obtainable between 9.0 a.m. and 5.15 p.m. (9 a.m. to 12.30 p.m. on Saturdays). Specimens received in the Public Health Department office are collected on Monday to Friday at 2 p.m. and at 10 a.m. on Saturday by a messenger from the Laboratory Service. Specimens may also be sent direct to the Hornsey Laboratory before 5 p.m. Monday to Friday and 12 noon on Saturdays. The Central Public Health Laboratory maintains a twenty-four hour emergency service. The assistance of the technical staff attached to the laboratories is also available in connection with outbreaks of infectious diseases at day nurseries and schools and this assistance is extremely valuable in controlling the spread of infection. 44 PUBLIC HEALTH LABORATORY SERVICE BACTERIOLOGICAL EXAMINATIONS Throat and Nose Swabs Diphtheria bacilli — Haemolytic streptococci 86 Vincents angina 1 Negative 191 — 278 Faeces Shigella 46 Salmonella 18 Protoza — Negative 428 Sputum Tubercular smear 4 Other organisms 21 Negative 32 — 57 Pertussis Cough Plates — Postnasal swabs 1 Negative 8 — 9 Milk Ice cream 34 Pasteurized 25 Other 10 — 69 Miscellaneous 719 1,624 45 There were no cases of diphtheria. NOTIFICATION OF INFECTIOUS DISEASE BY AGE AND SEX AGE IN YEARS Scarlet fever Whooping cough Acute Poliomyelitis (paralytic) Measles Meningococcal infection M F M F M F M F M F Under 1 — — 5 5 — — 9 11 1 — 1—2 2 2 19 17 — — 79 59 — — 3—4 14 11 11 15 1 - 94 109 — — 5—9 65 61 27 33 — — 230 232 — — 10—14 6 5 2 1 — — 3 3 — — 15—24 1 2 — — 1 — 2 — — — 25 and over 3 1 1 2 — — 1 3 TOTALS 91 82 65 73 2 — 418 417 1 — 173 138 2 835 1 AGE IN YEARS Acute pneumonia Dysentery Erysipelas Typhoid fever Food poisoning Puerperal pyrexia Paratyphoid fev ers M F M F M F M F M F M F M F Under 5 4 2 1 3 - - — — 1 1 — — 1 5—14 1 2 2 5 - i — — 2 1 — — — — 15—44 3 18 1 8 1 1 — 1 2 2 — 12 — 1 45—64 14 11 1 3 3 6 — — 1 — — — — — 65 and over 11 8 1 1 2 6 — — — — — — — — TOTALS 33 41 6 20 6 14 — 1 6 4 — 12 1 1 74 26 20 1 10 12 2 46 NOTIFICATION OF INFECTIOUS DISEASE BY WARDS Highgate M unwell Hill Crouch End Central Hornsey North Haringey South Haringey Stroud Green Finsbury Park Totals Scarlet Fever 5 28 6 35 18 18 37 26 173 Whooping cough 42 31 7 9 16 6 18 9 138 Acute poliomyelitis Paralytic — 1 1 — — — — — 2 Measles 39 80 52 143 129 177 129 86 835 Acute pneumonia 2 12 3 13 18 3 17 6 74 Dysentery 10 3 4 — — 1 5 3 26 Erysipelas 4 1 — 4 4 2 4 1 20 Meningococcal infection — — — — — — 1 — 1 Food poisoning — 5 — — 2 1 2 — 10 Puerperal pyrexia 1 7 — — 2 — 1 1 12 Typhoid fever — — 1 — — — — — 1 Paratyphoid fevers 2 — — — — — — — 2 TOTALS 105 168 74 204 189 208 214 132 1,294 47 TUBERCULOSIS The total number of cases on the Tuberculosis Register at the end of 1952 was 888, viz., pulmonary 785, non-pulmonary 103 Pulmonary Non-Pulm onary Total Male Female Male Female Male Female (a) Number of Cases on Register at commencement of year 421 325 56 46 477 371 (b) Number of Cases notified for first time during year under Regulations 39 31 3 2 42 33 (c) Cases restored to Register 3 2 — — 3 2 (d) Cases added to Register otherwise than by notification under Regulations (1) Transferred from other Districts 33 23 2 33 25 (2) From Death Returns 3 2 — 2 3 4 (e) Number of Cases removed from Register 54 43 3 5 57 48 (f) Number of Cases remaining on Register at end of year 445 340 56 1 47 501 | 387 48 Cases removed from Register shown under (e) are accounted for as follows | Found not to Removed to Died at Now Diagnosed be T.B. Recovered another area Died at home Sanatorium or as TOTAL other Institution Pulmonary T.B. M F M F M I F M I F M F M F M F | PULMONARY 1 — 9 11 32 25 7 2 5 5 — — 54 43 NON - PULMONARY — - 11 1 1 — — 1 2 1 3 5 49 CASES OF TUBERCULOSIS COMING TO THE KNOWLEDGE OF THE MEDICAL OFFICER OF HEALTH DURING THE YEAR under 1 1 year 2 to 4 5 to 9 10 to 14 15 to 19 20 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to over TOTALS BY FORMAL NOTIFICATION Pulmonary M - - - - - 1 1 10 13 7 4 2 1 39 70 F 1 - - - - 6 7 6 5 1 2 2 1 31 Non-Pulmonary M - - 1 - - - - 1 - - - 1 - 3 5 F - - - - - - - 1 1 - - - - 2 OTHER THAN BY FORMAL NOTIFICATION Deaths returns from Local Registrar Pulmonary M - - - - - — - - - - 1 - - 1 1 Inward transferable deaths Pulmonary M - - - - - 1 - - - - 1 - - 2 4 F - - - - - - - - 1 1 - - - 2 Non-Pulmonary F - - - - - - - - - 1 - - 1 2 2 Transfers from other Districts Pulmonary M - - - - - 1 8 15 4 4 1 — — 33 56 F - - - - 1 - 11 9 2 - - - - 23 Non-Pulmonary F - - - 1 - - 1 - - - - - - 2 2 GENERAL MEDICAL EXAMINATION OF STAFF Sixty-nine persons were medically examined to determine their fitness for acceptance on the permanent staff. Sixty eight were found to be fit. One of the conditions of the scheme for sickness pay for all employees who come within the scope of the National and Provincial Councils for Non-Trading Services (Manual Workers), which came into operation on the 5th July, 1948, is that all new employees be required to submit to a medical examination before the completion of six months' service with the Council in order to determine their fitness for admission to the scheme. Eighty-six persons were examined, eighty-two of whom were accepted for the scheme. Five other examinations were carried out for pension purposes. AREA HEALTH SERVICE The Personal Health Services now under the control of the Middlesex County Council are administered from the Area Health Office, Somerset Road, Tottenham, N. 17. Telephone number TOTtenham 4500. AREA WELFARE SERVICE The Welfare Service of the Middlesex County Council is administered in Hornsey by the Area Welfare Officer, 5 Lansdowne Road, Tottenham, N.17. Telephone number TOTtenham 1212, and it is to this officer that enquiries should be directed regarding the admission of persons to residential homes provided by the Middlesex County Council. LUNACY AND MENTAL TREATMENT ACTS The Authorised Officers for the purpose of these Acts have their offices at 1 Friern Park, N.12. Telephone number HILlside 9151. AMBULANCE SERVICE Ambulances are on call for urgent cases including maternity cases throughout the day and night. Telephone number MOU 2222. MEDICAL PRACTITIONER SERVICES IN HORNSEY The number of general medical practitioners in Hornsey has increased during the last year and now the South Haringey, Central Hornsey, Crouch End, Finsbury Park, North Haringey and Stroud Green wards are classified by the Medical Practices Committee of the Executive Council as intermediate areas, i.e. areas where the average practitioner has between 1,500 and 2,500 patients. The Highgate and Muswell Hill wards are classified as restricted areas where the average practitioner has fewer than 1,500 people on his list. Since the inception of the National Health Service Act there has been closer co-operation and establishment of cordial relations between 51 local medical practitioners and those engaged in the local authority's health services. So far as the Borough's work is concerned this has been most noticeable in the spheres of infectious disease control and in the care of the aged. HOSPITAL SERVICES IN HORNSEY The Hospital services in Hornsey are administered by the North-West Metropolitan Regional Hospital Board, 11a, Portland Place, W.l. through the Archway and Northern Hospital Management Committees as follows:— Archway Group — Offices: "Copley Dene," 46 Cholmeley Park, Highgate, N.6. Alexandra Maternity Home, Maternity 11 Alexandra Park Road, Muswell Hill, N.10. Tudor 1759. 29 beds. Hornsey Central Hospital, Park Road, Hornsey, N.8. General Mountview 6244. 61 beds. Santa Claus Home for Sick Children, Convalescent 55 Cholmeley Park, Highgate, N.6. Children's Home Mountview 4924. 26 beds. Northern Group:— Offices: Northern Group Hospital Management Committee, Royal Northern Hospital, Holloway Road, N.7. Coppets Wood Isolation Hospital, Coppets Road, Muswell Hill, N.10. Infectious diseases Tudor 9792. 144 beds. Radlett House, Southwood Lane, Highgate, N.6. Chronic sick Mountview 8778. 45 beds. Other Hospitals :— St. Luke's Woodside Hospital, In-patients Wing of the Woodside Avenue, Muswell Hill, Department of Psychological N.10. Tudor 8311. Medicine. (Administered by Middlesex 74 beds (7 private). Hospital, Mortimer Street, W.l.) 52 MASSAGE AND SPECIAL TREATMENT In June the Council decided to adopt Part XII of the Middlesex County Council Act, 1944, which relates to the licensing of shops for massage and special treatment. This section was brought into operation in Hornsey on 1st October and on and after that date any premises in the Borough used or represented as being used or intended to be used for the reception or treatment of persons requiring massage or special treatment must be licensed. The treatments are defined as (a) massage manicure or chiropody; or (b) electric treatment or radiant heat light electric vapour or other baths for therapeutic treatment; or (c) other similar treatment; Licences expire on the 31st March following the date of granting or renewal. The local authority is entitled to refuse to grant or renew a licence for several stated reasons and is empowered to authorise any officer to enter the premises specified in the licence, to inspect such premises and the records kept in connection with the work carried on under Part XII of the Act. Registered medical practitioners giving treatment which comes under this Part of the Act are exempted from all of the provisions of the Act on submission of a certificate signed by two other registered medical practioners and registered members of the Chartered Society of Physiotherapy are exempted from the need to obtain a licence on submission of a certificate signed by two registered medical practitioners. This certificate which must be in the form approved by the local authority expires on 31st January next following the date of the certificate and is renewed annually. Premises occupied by chartered physiotherapists are subject to inspection but no person other than a registered medical practitioner is entitled to inspect such premises or the records kept in connection with such establishments. Following is a summary of the premises which have been licenced under the Act :— Massage 6 Chiropody 14 Electrical treatment 5 Other similar treatment 3 Three members of the Chartered Society of Physiotherapy were granted certificates of exemption from obtaining a licence. 53 NATIONAL ASSISTANCE ACT, 1948 Section 47. Persons in Need of Care and Attention No person was compulsorily removed to a hospital or other place during the year. Complaints were received of aged persons living in insanitary conditions, who, it was alleged, were not receiving adequate care and attention. All complaints were investigated but many were unfounded. Generally aged persons are enabled to live alone very happily by the willing help of other occupants of their houses. This help may consist of bringing home the heavier shopping or by helpful encouragement in the home. Others receive great assistance from the Home Help Service or by the advice and guidance given by the Hornsey Old People's Welfare Committee. Of cases referred to the Health Department for action under the National Assistance Act, some have become beyond the care of neighbours though in some cases complaints are received which appear to be motivated by the desire of other occupants of the house to obtain more room. The following are brief reports on four typical cases investigated during the year. Case A.—Letters were received from the occupants of a house in the Borough regarding two sisters aged over 80 years who live together without adequate care in circumstances which were alleged to be insanitary. Upon investigation it was found that although one of the sisters never left the house she was able to be up each day and the other sister cared for her and cooked the meals. At the time of the visit, which was unexpected, the two old ladies had a fire lit in the living room and were enjoying a tea cooked and prepared by themselves, their own doctor calls fortnightly to see them. No further action was needed by the Department. Case B.—Complaints were received from the owner of a house regarding a woman of approximately 80 years of age living alone in insanitary conditions. After investigation and consultation with her doctor it was decided that this person should be removed to an institution. She was removed to a mental hospital under observation. Case C.—A woman of 85 years of age who had been helped for some considerable time but had refused admission to an Old People's home. Complaints were received from the health visitor and the home help service that the woman was very dirty and quite incapable of caring for herself. Her single room was dirty and foul smelling and the home helps refused to attend her. She was apparently in the habit of eating food which was unfit and, occasionally, raw meat or sausages. She was sometimes incontinent but not bedridden. Her condition deteriorated and she was admitted to hospital where she died. Case D.—a woman of 54 years of age whose physical age was over 80 years. Her rooms were well furnished but dirty and badly ventilated. No relatives could be traced. The other tenants complained of objectionable smells caused by varicose ulcers which the woman neglected. She was rather eccentric and ignored the advice of her doctor. A few days after inspection, this person was admitted to hospital where she died shortly afterwards. 54 Section 50. Burial or Cremation of the Dead. Arrangements were made for the burial of the bodies of eight persons who had died in the borough. Two were men and six women and all were over 70 years of age. Five died at home; two in the homes for old persons and one was found dead on an open space. VETERINARY INSPECTIONS Mr. F. G. Buxton, m.r.c.v.s., the Veterinary Inspector, has kindly supplied me with details of his work in the borough, under the Diseases of Animals Acts and Orders, during 1952 as follows:— No licences were issued under the Contagious Diseases of Animals Acts. One inspection was carried out under the Contagious Diseases of Animals Acts, as piggeries in Fortis Green. Four inspections were made under the Pet Animals Act, 1951. Two inspections were made under the Riding Establishment Act, 1939. No action was necessary under the Tuberculosis Order, 1925. PUBLIC MORTUARY The Hornsey mortuary and post-mortem room are situated at the Central Depot, Hornsey High Street. During the year 114 bodies were admitted and post-mortems carried out on all of them. Inquests were held on 7 bodies. 55 APPENDIX COUNTY COUNCIL OF MIDDLESEX AREA 3 HORNSEY AND TOTTENHAM REPORT OF THE AREA MEDICAL OFFICER The figures in tables 12-28 relate to Hornsey only and those in tables 1-11 to the whole of the area 57 MEMBERS OF LOCAL AREA COMMITTEE NO. 3 AS AT 31st DECEMBER, 1952 Members of Middlesex County Council County Alderman Mrs. K. M. St. P. Crump County Councillor Mr. M. W. Burns County Councillor Mr. R. A. Clarke County Councillor Mr. W. East County Councillor Mr. E. Harrison, S. de L., f.r.g.s., a.g.s.a. County Councillor Mrs. J. Thexton Members of Hornsey Borough Council Councillor Miss O. R. Anderson (Vice-Chairman) Councillor Mrs. D. F. Nott Councillor Miss J. Richardson Councillor Mr. C. V. Tipping Councillor Miss M. Toyne Members of Tottenham Borough Council Alderman Mr. A. Reed, A.C.I.I., J.P. Councillor Mr. R. W. H. Ford Councillor The Lady Morrison Councillor Mrs. A. F. Remington (Chairman) Councillor Mr. P. H. Roberts Councillor Mr. G. W. Rowley Member with knowledge and experience of of Home Nursing Mr. A. E. Stevens Nominated by:— The appropriate Hospital Management Committees Mrs. R. M. Fry Royal College of Midwives Miss V. Eady Middlesex Local Medical Committee Dr. E. C. Girling Middlesex Local Dental Committee Mr. R. W. D. Brownlie Middlesex Local Pharmaceutical Committee Mr. L. Hayward 58 CARE OF MOTHERS AND YOUNG CHILDREN (Section 22) Care of the Expectant Mother The well-being of the expectant mother from early pregnancy until confinement is the aim of all in attendance at ante-natal clinics. In this we have the co-operation locally of general medical practitioners, regional hospital obstetric consultants, almoners and others concerned in this service and who recommend mothers to attend local clinics to save time and unnecessary travelling. Abnormal cases are few in number and are referred to hospital for treatment. Where necessary, appointments can be made for X-ray and dental care and an ambulance booked to convey a mother between clinic and home. The card report system which was extended to Clapton Mothers' Hospital last year has operated successfully. Arrangements for domiciliary confinement or the reservation of a hospital bed are made for the mother at each local clinic. The services of a home help are available if required for all domiciliary confinements and temporary nursery accommodation can be provided for pre-school children in certain cases. In Hornsey, where the majority of hospital cases are booked for the Alexandra Maternity Home, there is a useful link in that two parttime ante-natal clinicians are also medical officers to the Home and general practitioners in the town. The health visitor in attendance at the clinic discusses arrangements with each mother and makes known to her the various services which are available to her during her pregnancy, confinement and puerperium. The maintenance of all these aids does much to prevent unnecessary worry and ill-health at a time when the mother is in most need of relief and support. Blood Tests All expectant mothers attending ante-natal clinics have specimens of blood taken for Wasserman reaction, blood grouping and determination of Rhesus factor. At some clinics patients have their haemoglobin estimated at the first visit and regularly every four weeks thereafter whether they are hospital or home confinements. The haemoglobin estimation is done by the Sahli method in the clinic by the same health visitors and checks are made on the accuracy of the estimations from time to time by co-operation with the Pathologist of the Post-Graduate Medical School, Ducane Road, W.12. The results have been accurate within 5 per cent. A record is kept of the patient's ability to take iron and the type most easily tolerated. 59 Relaxation and Mothercraft Classes This service is now operating in three Hornsey and three Tottenham clinics and is much appreciated by expectant mothers. The group teaching is in all cases given by a health visitor whose aim is to dispel fears associated with pregnancy and confinement and to instruct mothers on those matters associated with the well-being of themselves, normal childbirth and the preparation for the care of their children. The classes are kept as informal as possible and time is allowed for questions and answers as well as for a cup of tea. Many mothers return post-natally for exercises and to consult the health visitor. Notification of Births—Home and Institutional Confinements It will be observed from the table set out below that more than 80 per cent. of the births which occurred last year were in hospital and nursing homes. The number of home confinements has dropped steadily since the peak birth rate year of 1947. It is interesting to note that this drop continued over the last three years even though the number of births has remained fairly steady. It would appear that while the hospitals are able to provide a sufficient number of beds for maternity cases, mothers are being discouraged from having their babies at home, especially as it is less expensive for them to go into hospital. Because of the lack of discrimination in favour of admission to hospital on purely obstetric or social grounds difficulty sometimes arises in finding a bed in an emergency, as all hospital accommodation has been taken up. The number of institutional confinements in Hornsey is undoubtedly increased by the existence in that borough of the Alexandra Maternity Home which accommodates over 600 Hornsey births each year. In Tottenham, on the other hand, there is evidence that hospital accommodation is more limited and is always taken up. The Tottenham patients make use largely of the North Middlesex Hospital and the Mothers, Hospital, Clapton. These, together with the Alexandra Maternity Home, take nearly two-thirds of the institutional births of the area, and with all of them there is close co-operation. The majority of the remainder of the institutional confinements take place in hospitals in Central London, although some 47 mothers were last year confined at private or voluntary assisted nursing homes in Hornsey. The trend to hospital confinements is a National one and the Minister of Health issued a circular on the subject in August, 1951, stating that though it was not possible to lay down a proportion of births for which hospital or maternity home beds should be provided, in general, hospital provision is required on medical or social grounds for about half the confinements. In this area well over half of the confinement are in institutions but at the same time some of the 17 per cent. of 60 home confinements, should have been in hospitals and closer co-operation than already exists is needed to ensure that the right patients are admitted to maternity beds. TABLE 1 1952 1951 1950 1949 1948 1947 Total Births (Live and Still) 3,265 3,162 3,261 3,672 4059 4,935 Institutional Births 2,679 2,487 2,394 2,706 2,754 2,684 Percentage of Total 82.1 78.6 73.4 73.7 67.8 54.4 Domiciliary Births 586 675 867 966 1,305 2,251 Percentage of Total 17.9 21.4 26.6 26.3 32.2 45.6 Ante-natal Clinics The average attendance at ante-natal clinics continues to decline but has not yet reached the stage where any curtailment in the number of sessions held is desirable. The following table shows the attendance at clinics during 1952 and the totals for the preceding three years are given for purposes of comparison. Separate post-natal clinics are not held. TABLE 2 Ante-natal Clinics No. of sessions hold No. of new cases Total attendances Average attendances per session A.N. P.N. A.N. P.N. Burgoyne Road 50 141 87 987 91 25.6 Church Road 78 145 58 1,287 62 17.3 Fortis Green 61 223 148 1,540 161 27.9 Hornsey Town Hall 211 313 177 2,893 181 14.6 Mildura Court 62 199 64 1,363 64 23.0 Stroud Green Road 51 158 72 891 74 18.9 The Chestnuts 256 511 253 3,326 265 14.0 Lordship Lane 206 405 228 2,758 233 14.5 Park Lane 103 366 246 2,018 246 21.9 Totals 1952 1,078 2,461 1,333 17,063 1,377 17.1 1951 1,038 2,439 1,330 16,999 1,332 17.7 1950 1,082 2,594 1,303 19,006 1,331 18.7 1949 1,074 2,714 1,438 20,617 14,91 20.6 61 Midwives Clinics Domiciliary midwives assist at all but two of the ante-natal clinics. An attempt is made to ensure that this work is done by the midwife who is likely to deliver the patient in each case. In four centres separate midwives clinics are held and the following table shows the attendances made during the year. TABLE 2a Midwives' Clinics No. of sessions held No. of new cases Total No. of attendances Average attendance per session Burgoyne Road 49 15 239 4.9 Fortis Green 42 5 278 6.4 Park Lane 101 — 1,145 11.3 Stroud Green Road 47 2 304 6.5 Totals 239 22 1,966 8.2 Post-natal Care An appointment is made for each mother to attend for a post-natal examination at the clinic which she attended as an expectant mother, approximately six weeks after the confinement. Here she is seen by the doctor who undertook her ante-natal care and who knows her and any special features connected with the case. The hospital's or midwife's report on the confinement is held in readiness for this examination so that the examining doctor knows all the facts connected with the case. Each mother is encouraged to keep this appointment so that any defects which may have resulted from her confinement are detected and treated at once so as to avoid future disability. Care of Premature Infants There is an agreement with the North Middlesex Hospital for the admission of any woman in premature labour, to avoid delivery at home and later transfer to hospital. The hospital will admit the case on a midwife's or doctor's request, and this applies also to the need to transf er a premature child born at home. 62 Premature babies delivered at home. The case is graded according to the baby's requirements. More frequent visits and a special nurse, if necessary, special clothing, hot water bottles and breast milk (when available) are loaned out. Special cots are not provided. Supervision of the infant is continued for as long as required. Infant Welfare Centres In nine centres doctors and health visitors with special qualifications in child health attend to give advice to mothers of healthy infants on normal development and progress. Regular weighing and physical examination brings to light the smallest deviations from normal growth and well-being, and these deviations are investigated with the mother so that they can be remedied. In the early months of life advice on feeding is frequently sought, particularly for infants who are artificially fed and those who have reached the weaning age. This service does much to ensure the growth of a healthy child and is a means of educating mothers on the proper care of their children. Sessions are also held at which the health visitor alone is in attendance and where time can be given to test-feeding, etc. These clinics have a vital part in promoting child health. Attendances have been well maintained during the year and the first attendances of children under one year of age represent 87 per cent. of the notified live births. All children, especially new babies, are followed-up by health visitors home visits. The inter-relationship of infant welfare clinics and home visiting are obvious as is also the fact that with the present staff of health visitors it would be impossible to supervise the health of so many children by visiting only. Toddlers Clinics Toddlers clinics are now held at all nine centres. This is an increase of one over 1951. Appointments are made for a six monthly or more frequent medical overhaul for those children who do not receive medical examination at other clinics or at day nurseries, nursery schools or classes. Appointments are welcomed by parents. The purpose of these examinations is to detect and correct mental or physical defects and maintain the good health of children in the 2-5 years age group so that they are in good condition before attendance at school. 63 TABLE 3 Infant Welfare Centres No. of sessions held First attendances Total attendances Seen By Doctor Average attendances Under 1 Over 1 Under 1 Over 1 Burgoyne Rd. 156 205 16 3,771 959 1,325 30.3 Church Road 153 199 10 3,619 969 1,656 29.9 Fortis Green 203 250 2 4,271 1,116 1,555 26.5 Hornsey Town Hall 208 402 25 5,709 2,206 3,323 38.0 Mildura Court 106 166 8 3,005 1,469 1,675 42.2 Stroud Green 104 187 8 2,963 997 802 38.8 The Chestnuts 257 566 34 7,204 1,804 2,349 35.6 Lordship Lane 258 432 35 6,391 1,773 1,480 31.2 Park Lane 207 379 14 5,530 1,362 1,571 32.3 Toddlers Sessions Burgoyne Rd. 24 — 7 — 439 439 18.3 Church Road 46 — 8 — 486 480 10.5 Fortis Green 26 — 15 — 378 378 14.5 Hornsey Town Hall 50 - 27 - 584 575 11.7 Mildura Court 41 — 17 — 721 607 17.6 Stroud Green 6 — 9 — 89 88 14.8 The Chestnuts 53 — — — 698 698 13.1 Lordship Lane 51 — 16 — 822 822 16.1 Park Lane 106 — 2 — 897 892 8.5 Totals 1952 2,055 2,786 253 42,463 17,769 20,715 29.3 1951 1,918 2,754 453 37,759 18,253 19,008 29.2 1950 1,781 2,735 290 41,171 18,625 18,427 34.1 1949 1,810 3,212 1,575 47,009 20,351 20,197 37.2 Child Life Protection The Area Children's Officer and his staff are responsible for adoption arrangements and the care of children deprived of a normal home life, but there are border-line cases of child neglect which are watched carefully by health visitors in the normal course of the supervision of child health and well-being. This usually acts as a deterrent but if necessary the health visitor warns careless or neglectful mothers of the consequences of their behaviour. Only a few of these cases deteriorate and those and any doubtful cases are reported to the Area Children's Officer or the N.S.P.C.C. Daily Guardian Scheme This scheme, by which working and other special categories of mothers are assisted in finding suitable daily minders for their children, operates exceedingly well. In spite of a certain wastage in daily guardians, the number of women who offer their services, considerably exceeds the 64 present demand. At the end of 1952 there were 161 daily guardians on the register of whom 76 were minding 88 children. The number of individual children minded during the year was 148 and they were in the care of guardians for 18,876 days. These figures compare with 129 and 15,710 respectively for 1951. Health visitors undertake to approve guardians for registration and are responsible for vigilance in seeing that the scheme's safeguards are carried out. Day Nurseries The County Council's new policy on the admission of children to day nurseries and the charges for admission, which came into operation on the 1st December, had the effect of drastically reducing the numbers on the registers and the daily attendances by the end of the year. The following table shows the number of children on the registers at the end of the year and the attendances during the year. Comparative totals for 1951 are also shown. TABLE 4 Day Nursery No. of approved places at end of of year No of children on register at end of year Attendances Average daily attendances 0—2 years 2—5 years 0—2 years 2—5 years 0—2 years 2—5 years 0—2 years 2—5 years Ladywell 24 50 19 33 4,672 10,367 18 40 Stoneeroft 15 45 13 27 3,155 9,652 12 38 Red Gables 23 23 14 16 4,317 5,623 17 22 Park Lane 20 30 16 21 3,408 6,131 13 24 Lordsliip Lane 10 30 9 22 2,452 5,419 10 21 Plevna Crescent 20 30 12 34 2,517 8,974 10 35 Totals 1952 112 208 83 153 20,521 46,166 80 180 1951 112 208 114 232 21,867 45,479 85 177 65 Priority Dental Service The following table shows the work carried out by the dental officers during the year. The work done during 1951 is also given for purposes of comparison. TABLE 5 1952 1951 Expectant & Nursing Mothers Children under 5 Expectant & Nursing Mothers Children under 5 No. examined by dental officer 226 1,127 43 879 No. referred for treatment 211 992 42 795 New cases commenced treatment 179 876 37 715 Cases made dentally fit 77 663 21 462 Forms of dental treatment provided: Teeth extracted 200 879 53 893 Anaesthetics: (a) Local 64 192 10 196 (b) General 40 308 9 275 No. of fillings 234 1,562 35 1,005 No. of root fillings — — 1 — No. of crowns and bridges — — — — No. of inlays 2 — — — Scalings and gum treatment 72 - 16 - Silver nitrate treatment — 1,165 - 944 Dressings 81 752 6 687 Other operations 11 106 1 94 No. of Radiographs: (a) at County Council clinics 5 2 - 2 (b) at hospital 2 — — — Denture dressings 73 — 55 — Dentures fitted: (a) full 5 — 6 — (b) partial 14 - 8 — No. of attendances 468 2,114 104 1,663 No. of appointments not kept 170 306 16 230 No. of half days devoted to service 379 1/2 212 66 MIDWIFERY SERVICE Section 23 During 1952, one of the domiciliary midwives retired and another retired at the beginning of 1953. A third midwife has submitted her resignation and will have left the County Council's service by the end of February, 1953, so that the number of midwives employed has fallen from 15 to 12 in less than a year. It has not been considered necessary to replace them as the decline in the number of home confinements, to which reference was made in my annual report for 1951, has continued. Supervision of Midwives Inspections of registers of births, equipment and drug books are carried out at six-monthly intervals. Once yearly a visit is made to the midwife's home by the senior assistant medical officer and routine inspection carried out. Supervision of practical work at six-monthly intervals, also attendance of non-medical supervisor at any confinement where the midwife becomes anxious or is out over a period of many hours. A weekly meeting of domiciliary midwives is held for the purpose of general discussion of cases, problems connected with the work and matters of interest connected with midwifery. In addition, the nonmedical supervisor is in touch with each midwife daily, either personally or by telephone. Co-operation with General Practitioners New general practitioners are visited by the midwife working in his area, or by the non-medical supervisor, and his wishes regarding care of ante-natal patients ascertained. The degree of care of practitioners' cases by the midwife is based on the individual requirements of each doctor. In Hornsey most of the practitioners' cases attend the local authority clinics. This is also done in Tottenham but to a lesser degree. Relations between doctors and midwives in this area are extremely cordial. 67 TABLE 6 Maternity cases attended by County Council Domiciliary Midwives:— 1952 1951 1950 As Midwife 496 589 708 As Maternity Nurse 59 71 154 Totals 555 660 862 Administration of Gas and Air Analgesia by County Council Domiciliary Midwives:— 1952 1951 1950 As Midwife 360 368 352 As Maternity Nurse 36 30 89 Totals 396 398 441 Medical Aid:— 1952 1951 1950 (a) Number of domiciliary cases in which medical aid was summoned:— (i) where tho modical practitioner had arranged to provide the patient with maternity medical services under the National Health Service 34 12 24 (ii) Others 100 166 162 (b) For cases in institutions 11 13 5 Totals 145 191 191 HEALTH VISITING Section 24 Each health visitor is attached to a maternity and child welfare centre in the area which is near to the district which she covers for home visiting. By this means each mother associates the health visitor with the ante-natal, infant welfare, school health and other special clinics which are held in the centre near to her home. This arrangement makes for accessibility, ease of approach and confidence in continuity on both sides when visiting, advice or assistance are required. Apart from home visiting and clinic duties health visitors have been engaged on completing questionnaires for special investigations for for such bodies as the Ministry of Health, the Medical Research Council, the National Birthday Trust and the Institute of Child Health, and have provided other reports for no less than twenty-two different hospitals in or near the London area. Health visiting in schools also takes up a proportion of each health visitor's time. This includes attendance at routine hygiene examinations 68 and medical inspections. Requests for health education in schools are increasing and during the year no less than 73 talks were given by health visitors to classes of school leavers at secondary modern schools in the area. Health talks were also given to outside bodies such as Young Wives Clubs, Wesley Guilds, the Women's Branch of the British Legion and the Girl's Life Brigade. Clinic nurses have undertaken some of the routine work in clinics and schools to give health visitors time for their more essential duties. TABLE 7 No. of visits paid by all Health Visitors working in the area to: 1952 1951 First Visits Total Visits First Visits Total Visits Expectant Mothers 2,077 3,332 1,721 4,544 Children under 1 year 3,204 15,241 3,158 13,825 Children 1-5 years 15 20,804 27 18,146 Children of school age 1 3,417 5 2,367 Other persons 3,101 4,010 1,969 3,253 Totals 46,804 42,135 Number of health visitors employed at end of 1952:— (a) Whole time on health visiting — (b) Part time on health visiting 29 (c) Equivalent whole time health visiting service provided under (b)—including attendances at clinics 22 Co-operation of General Medical Practitioners One factor which must influence the working of the local health services is the growing co-operation between the family doctor and health visitor. This is developing in the following ways. Health visitors have called upon or contacted general medical practitioners by telephone on such matters as feeding difficulties of babies, illness of mothers, including mental disturbances, illness of aged persons, to discuss departures from normal health of mothers and children of pre-school or school age, to report the illness of a child suspected of neglect. General medical practitioners have assisted the Health Department by referring expectant mothers to local clinics for additonal ante-natal care, by requesting the services of home helps for sick people or for the aged, by referring cases for convalescence, by reporting cases of persons who were not able to care for themselves properly and for whom hospital accommodation was unobtainable, and also for passing on advice or information to the health visitor on those cases in which the health visitor sought the family doctor's advice. 69 In my opinion this interchange of information and assistance is to be commended as providing a better service for the public and more cordial relations between members of the local health service. Ministry of Health Food Survey This survey was undertaken with the assistance of health visitors in January and about twenty-five Tottenham mothers took part in it with the field workers of the Ministry. Virus Infection During Pregnancy Health visitors and medical staff are assisting in keeping records of a group of mothers in this and other areas from pregnancy until the child's second birthday. This information is being obtained for the Ministry of Health investigation of virus infections during pregnancy HOME NURSING Section 25 The demands on the home nursing service continued to increase during 1952 and at the end of the year the nursing staff was very nearly up to full establishment. It was not found any easier to recruit resident nurses to live in Bruce Grove Nurses Home, Tottenham, and in fact, by the end of the year, the numbers in residence (including the Superintendent) had fallen from 6 to 4. TABLE 8 Males over 14 Females over 14 M. & F. 14 and under Total Cases on register on 1-1-52 136 304 9 449 New cases during the year 869 1,632 237 2,738 Cases completed during the year 867 1,584 244 2,695 Cases remaining on register on 31-12-52 138 352 2 492 Total number of visits during 1952—77,113. Total number of visits during 1951—62,124. Co-operation with General Practitioners Work from the doctors is received at Bruce Grove Nurses Home or the Area Health Office and the visits are distributed from those points. Co-operation is good and the doctor is able to make any special point when he requests the services of a nurse. A message sheet is left at the patient's house for the exchange of notes between doctor and nurse. No service has been arranged for night work but requests have been very few. The emergency calls for a nurse between the hours of, say, 7 and 10 p.m. are also few and have been met without great difficulty. 70 VACCINATION AND IMMUNISATION Section 26 Vaccination During the year the Minister of Health approved an amendment to the County Council's Proposals as to Vaccination and Immunisation made under the National Health Service Act to the effect that facilities would be made available at the clinics for infant vaccination by medical officers in addition to the service provided by general practitioners. This scheme has been well received by the mothers and it is hoped that with its gradual development the percentage of infants vaccinated will steeply rise; but even more intensive education of parents on the importance of vaccination is required. Vaccination is being carried out on infants, preferably at four months but not over 12 months old. The following table records the number of persons known to have been vaccinated or re-vaccinated during 1952:— TABLE 9 Under 1 year 1 year 2-4 years 5-14 years 15 years and over Total (i) No. of persons primarily vaccinated 937 55 38 54 135 1,219 (ii) No. of persons re-vaccinated - - 10 101 379 490 Immunisation As stated in my last annual report the County Council agreed to make available free whooping cough vaccination at all immunisation clinics following the success achieved by the controlled experiments carried out in this and other districts by the Medical Research Council at the request of the Ministry of Health from 1950 to 1952. The introduction of the new combined diphtheria pertussis vaccine suspension now gives protection against diphtheria and a degree of protection against whooping cough in a total of three injections. This reduced total of injections is very popular with the mothers and it is anticipated that the percentage of immunised children will show a satisfactory increase during 1953. The series of three injections is commenced at the age of six months wherever possible. The mothers are informed that while a degree of protection against whooping cough will be obtained it is less certain than protection against diphtheria. It is felt that this warning is necessary to prevent immunisation against diphtheria falling into disrepute should the child subsequently develop an attack of whooping cough. The following table records immunisations carried out by area medical staff as well as general medical practitioners during 1952:— 71 TABLE 10 Age at date of immunisation No. of children immunised No. of children given re-inforcing injections Diphtheria only Combined Diphtheria and Whooping Cough Whooping Cough only Diphtheria only Combined Diphtheria and Whooping Cough Under one 1,094 115 218 - - One 690 77 642 — — Two 96 3 98 — — Three 52 4 41 5 - Four 41 1 23 347 4 Five to nine 66 3 10 868 7 Ten to Fourteen 14 - — 42 — Totals 2,053 203 1,032 1,262 11 PREVENTION OF ILLNESS, CARE AND AFTER CARE Section 28 Recuperative Holiday Homes During the year, area health staffs continued to be responsible, on behalf of the County Health Department, for dealing with applications for admissions to recuperative holiday homes. The following table shows the cases dealt with during the year:— Applications Admissions to recuperative received holiday homes recommended Adults 323 266 Children 21 12 72 DOMESTIC HELP SERVICE Section 29 The County Council's scheme for the provision of home help in accordance with the rules governing priorities is being operated. There has been a falling off in the demand for this service which was sharply accentuated in 1952. There is good liasion with the Old People's Welfare Committees in Tottenham and Hornsey and with the W.V.S. regarding the provision of meals on wheels. The following table is of interest in demonstrating the falling demand in new applications coupled with the increase in the number of old cases being served. TABLE 11 Maternity T.B. Others Total Comparative Totals 1052 1951 1950 1949 No. of approved applications for service of home help received 126 39 514 679 853 925 1,013 No. of new cases in which help has been provided 93 35 510 638 812 884 1,011 No. of old cases in which help has been provided 4 74 527 605 531 430 372 Number of helps employed at 31-12-52 (whole time) 7 Number of helps employed at 31-12-52 (part-time) 116 Equivalent number of whole-time helps employed at 31-12-52 70 MENTAL HEALTH SERVICES Section 51 During the year the County Council delegated to the Area Committee, for an experimental period of twelve months, certain functions relating to the day-to-day administration of the Hornsey Occupation Centre. It is considered that the arrangement has worked satisfactorily and it provides a link between the Mental Health Sub-Committee and the Area Committee. 73 SCHOOL HEALTH SERVICE Routine Medical Inspections Three times in the child's career the routine medical inspection brings together child, parent, teacher, nurse and doctor and the routine medical examination achieves best results when first, the child is seen by the nurse; second, the doctor interviews the head teacher, and finds out if the head teacher from his or her day to day observation of the child suspects-any deviation from normal health. The doctor, having the nurse's report, then interviews parent and child, questions are invited and problems relating to health explored, the child is examined and if a defect is discovered the parent is advised. However, in most cases the doctor and parent agree that the child is healthy, sometimes the mother needs to be re-assured that her anxieties are unfounded. The mother is advised to accept the first year of school life as a period when upper respiratory tract infections are common and to accept that the apparent thinness of the junior school child (ages 8, 9 and 10) is compatible with good health. When the routine medical inspection is completed the doctor reports relevant findings to the head teacher and makes any necessary arrangements for the disposal, treatment or follow-up observation of defects found. Dental Service During 1952 the dental staff was increased to seven full-time dental surgeons so that all dental surgeries were fully staffed. It is hoped that during 1953 two additional dental clinics may be set up and staffed so as to allow a complete school dental and priority dental service for expectant and nursing mothers and children under school age to be maintained. The scheme for evening dental sessions which commenced on the 1st January, 1952, enabled a total of 136 additional treatment sessions to be held at which 890 attendances: were made. This contribution was equivalent to another full-time dental surgeon being employed for three months during the year. Tottenham Day Special School for the Deaf The nursery block was completed during the year and eleven deaf children of nursery school age are now being accommodated. Vale Road Day Special School for Physically Handicapped Children Spastic Unit The formation of the spastic unit at Vale Road Special School for Physically Handicapped Children, by building additional classrooms, has not yet materialised owing to unforseen building difficulties. It is hoped that a start will soon be made on the building work so that the unit may come into full operation. 74 During the year in spite of many difficulties, more physiotherapy and speech therapy sessions have been devoted to cerebral palsy cases attending the school. In addition, arrangements were made for some of the children to receive physiotherapy during the school holidays. Children whose parents were agreeable, were transported by the ambulance service during the Christmas holiday to a school clinic, thus ensuring continuity of treatment. It is hoped to continue these holiday arrangements during 1953. Some of the special equipment required for the use of the unit has been obtained. Other equipment, including special desks and chairs, will be obtained when the additional accommodation is available. Physiotherapy The approved establishment of physiotherapists for the area is three. Their work is not only concerned with orthopaedic cases attending one or other of the clinics, but is essential for the needs of spastic children attending the special school for physically handicapped children. Between February and June 1952, two full-time and two part-time physiotherapists were employed, equivalent to two and seven-elevenths full-time staff. At the time of writing the strength is one and nineelevenths, the children at Vale Road are now receiving totally inadequate treatment and the inability to fill the vacancies is causing grave concern to the orthopaedic surgeons and the staff of the school. Speech Therapy A second speech therapist for Tottenham was appointed in April, 1952. Two others work part-time in Hornsey. This increase in staff has made possible a daily session at Vale Road Special School for Physically Handicapped Children, where two therapists, one with specialist training, treat children suffering from cerebral palsy. The importance of the preventive aspect of the work is becoming increasingly recognised. More pre-school children are seen. An indirect approach, through parent education, has proved of value in the treatment of early stammer, or delayed speech development, while suspected sensory loss or organic lesion require the earliest expert investigation. Work with a recording apparatus has shown the possibilities of such equipment as an aid to treatment. Report on the Rheumatism supervisory scheme for the year 1st August, 1951 to 31st July, 1952. This rheumatism supervisory scheme was inaugurated on 1st August, 1951, under the overall direction of Dr. I. M. Anderson, Paediatrician, Prince of Wales's Hospital, with the close co-operation of the local Public Health and Area Health Departments. The children are referred to the clinics by their private doctors and through the School Health Service. A number of children are also admitted directly to the paediatric wards of the Prince of Wales's Hospital and St. Ann's General Hospital suffering from acute rheumatic fever and allied conditions. After discharge from hospital these patients attend the supervisory clinic. 75 The supervisory clinics for follow-up are held on alternate Monday mornings in the Out-patients Department of the Prince of Wales's Hospital. The routine examinations are carried out by the paediatric registrar and an assistant medical officer, assisted by a sister-in-charge and a clerk from the Area Health Office. Both new and old patients are seen at each session. In the case of new patients a full history is taken and a complete clinical examination is carried out. The various forms are then completed and other investigations, where necessary, such as X-rays and electrocardiographs are performed. After these preliminary procedures the patients are seen by Dr. Anderson on Tuesday and Thursday mornings at the Prince of Wales's Hospital. At this examination and from the results and reports previously obtained the diagnosis and clinical assessment are made and recommendations regarding future schooling are sent to the School Health Authorities. After this initial assessment the patients are seen at regular intervals at the supervisory clinic by the paediatrician or local authority medical officer and should any significant change appear in the clinical condition they are again referred to Dr. Anderson for further discussion regarding treatment or special educational requirements. During the year 37 patients suffering from acute rheumatism, chorea or recurrences were treated in the wards. While the number of longstay in-patients was increasing it became apparent that some educational provision would become necessary and arrangements were made through the Borough Education Officer for Tottenham to provide a hospital teacher. The following table gives details of the patients referred to the supervisory centre during the year:— 76 Rheumatism and allied disorders Congenital heart lesions Number of patients: Male 35 27 Female 40 20 75 47 Resident in Area 3 (Tottenham and Hornsey) 56 30 Resident in other areas 19 17 Diagnosis: 1. Rheumatic pains without heart disease 18 — 2. Rheumatic heart disease (active) (a) Alone 12 — (b) With polyarthritis 13 — (c) With chorea 3 — 3. Rheumatic heart disease (quiescent) 24 — 4. Rheumatic chorea (alone) 5 — Referred by: Family Doctor 54 27 School Health Service 20 19 Hospital 1 1 Reason for reference to clinic: Symptoms 69 11 Accidental finding 6 36 Health in 1st year of life: Satisfactory 55 21 Unsatisfactory (chiefly respiratory infections) 20 25 No record — 1 Disposal: Admitted to hospital (St. Aims) 37 17 Admitted to hospital (pre-scheme) 3 2 Out-patient supervision only 35 28 School Attendance: Ordinary—Full 60 29 Limited 10 1 Special—Day 2 3 Residential — 1 Pre-school 3 10 Still in-patient in hospital — 3 77 ANALYSIS OF SOME FACTORS IN THE RHEUMATIC GROUP Significant family history of rheumatic disorders 25 Housing conditions: Satisfactory 33 Unsatisfactory 16 No report 26 Psychosomatic assessment (by clinical judgment and school reports) Stable, well-balanced personality 54 Emotionally disturbed or unstable 21 Health in 1st yeah of life: Satisfactory 55 Unsatisfactory (ohiefly respiratory infections) 20 Significance of blood anti-stbeptococcal tithes: Number of patients suffering from non-rheumatic disease Titres between 1/40 and 1/80 20 Number of patients suffering from rheumatic fever or recurrence, of the following titres:— 1/40 1 1/160 3 1/320 4 1/640 4 1/1280 3 Child Guidance A proposal to establish a child guidance centre in Tottenham, within the existing accommodation at the Cornwall Road School Clinic, was approved during the year. The necessary alterations to the premises have, at the time of writing, been almost completed and it is anticipated that the centre will commence operations in April, 1953. Such a centre will be of great benefit to Tottenham mothers and children and will save them the long journey to the Child Guidance Training Centre in London. B.C.G. Inoculations The Medical Research Council continued their investigations in the area into the prevention of tuberculosis by B.C.G vaccination. In 1951 the investigation had been concerned with accepting "school leaver" volunteers into the scheme. In 1952 the important task of following up the inoculated and the control groups was commenced. It can easily be appreciated that the success of the trial depends on the completeness of the follow-up, for without being able to assess the results of B.C.G. vaccination by comparing a large inoculated group with a control group no estimate of the value of the vaccine can be obtained. The follow-up is carried out in three ways:— (1) An annual x-ray and skin test. Sessions are held at a convenient centre between 4.30 p.m. and 8 p.m. to enable young people who are at work to attend with the minimum of disruption to their employers. The employers themselves are encouraged, by means of letters sent out by the Youth Employment Officer, to release any of their employees who are included in the trials. Publicity is also given in the press and by slides at local cinemas. 78 (2) Visits by Health Visitors. Prior to the annual X-ray the health visitors visit the volunteers to complete questionnaires concerning their state of health. Particular regard is paid to illnesses of more than two days duration and to any visits to hospitals or clinics. The opportunity is also taken to remind them of the importance of attending for annual X-ray. (3) Co-operation with Chest Clinics. The Chest Physicians supply information to the Medical Research Council with regard to children in the age groups covered by the investigation who are known to the Chest Clinics. In 1952 the Lordship Lane Medical Centre was used for the follow-up and out of 213 children who left school at the end of the 1951 summer term, 172 returned for X-ray. This represents a figure of 81 per cent, and in the words of Dr. Pollock who is in charge of the trials on behalf of the Medical Research Council "is a very good figure and we have every reason to be pleased with the success achieved." Statistical Information The following tables relate to the work of the School Health Service during 1952. 79 TABLE 12 PERIODIC MEDICAL INSPECTION Period Medical Inspections Other periodic inspections Entrants Second age group Third age group Total 1,241 904 477 2,622 1,219 Other Inspections Special inspections Re-inspections 1,648 1,297 TABLE 13 CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS Age Groups No. of pupils inspected A (Good) B (Fair) C (Poor) No. % No. % No. % Entrants 1,241 581 46.8 648 52.2 12 1.0 Second Age Group 904 380 42.0 507 56.1 17 1.9 Third Age Group 477 254 53.2 219 45.9 4 0.9 Other periodic inspections 1,219 443 36.3 766 62.9 10 0.8 TOTAL 3,841 1,658 43.2 2,140 55.7 43 1.1 80 TABLE 14 DEFECTS FOUND BY MEDICAL INSPECTION Defect or Disease Periodic Inspections Special Inspection No. of Defects No. of Defects 1. 2. 1. 2. Skin 20 15 241 5 Eyes a. Vision 104 48 76 2 b. Squint 34 7 8 2 c. Other 26 25 113 3 Ears a. Hearing 9 7 20 1 b. Otitis media 1 8 17 — c. Other 9 6 92 — Nose and Throat 64 99 45 1 Speech 13 17 17 1 Cervical Glands 9 32 13 1 Heart and Circulation 4 28 11 — Lungs 16 21 76 1 Developmental— a. Hernia 2 2 1 — b. Other — 1 6 — Orthooaedic— a. Posture 15 31 6 1 b. Flat foot 38 31 10 — c. Other 82 46 82 4 Nervous Svstem— a. Epilepsy — 1 2 — b. Other 3 13 8 2 Psvcholoeical— a. Development - 17 40 1 b. Stability 5 19 21 1 Other 67 125 1,004 20 1. Requiring treatment. 2. Requiring to be kept under observation but not requiring treatment. 81 TABLE 15 PUPILS FOUND TO REQUIRE TREATMENT Number of individual pupils found at periodic medical inspection to require treatment (excluding dental disease and infestation with vermin.) Group For defective vision (excluding squint) For any of the other conditions recorded Total individual pupils Entrants 3 56 59 Second Age Group 31 97 118 Third Age Group 6 15 20 Total (prescribed groups) 40 168 197 Other periodic inspections 30 56 74 GRAND TOTAL 70 224 271 TABLE 16 MINOR AILMENTS Number of cases treated or under treatment during the year by the Authority Otherwise (a) Diseases of the Skin (excluding uncleanliness) Ringworm—(i) Scalp — — (ii) Body 2 — Impetigo 27 — Other skin diseases 259 — TOTAL 288 — (6) Other treatment given not covered by other Tables. Number of cases treated by the Authority Otherwise Miscellaneous minor ailments 946 5 Heart and Circulation 4 1 Lungs 8 12 Psychological 31 3 Developmental 5 — TOTAL 994 21 82 TABLE 17 EYE DISEASES, DEFECTIVE VISION AND SQUINT Number of cases dealt with by the Authority Otherwise External and other, excluding errors of refraction and squint 235 177 Errors of Refraction (including squint) 558 23 TOTAL 793 200 Number of pupils for whom spectacles were prescribed 288 133 The responsibility for the provision of spectacles was transferred to the Regional Hospital Board with effect from 1st October, 1952. TABLE 18—DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Number of cases treated by the Authority Otherwise Received operative treatment for adenoids and chronic tonsillitis — 2 Received other forms of treatment 578 — TABLE 19—ORTHOPAEDIC AND POSTURAL DEFECTS Treated in Orthopaedic Clinic— New Cases 561 Under treatment at end of year 208 Total attendances 2,177 Treated otherwise 7 TABLE 20—CHILD GUIDANCE AND SPEECH THERAPY Child Guidance Speech Therapy Number of pupils treated by the Authority 42 161 83 TABLE 21 DENTAL INSPECTIONS AND TREATMENT AGE GROUPS No. inspected (i) No. found to require treatment (ii) No. referred for treatment at the County Council's Dental Clinics (iii) Under 5 - — — 5—16 and over 3,752 2,571 1,474 Specials 1,938 1,898 1,893 TOTALS 5,690 4,469 3,367 Number of pupils commenced treatment 2,585 Number of pupils treatment completed 2,115 Number of attendances made by pupils for treatment 7,026 Number of appointments not kept 1,215 Number of half days devoted to (a) Inspection 394 (b) Treatment 1,4861 Fillings—Permanent Teeth 3,862 Temporary Teeth 1,601 Number of teeth filled—Permanent Teeth 3,224 Temporary Teeth 1,512 Extractions—Permanent Teeth 348 Permanent Teeth for Orthodonture 83 Total Permanent Teeth 431 Temporary Teeth 2,863 Anaesthetics—(a) General 701 (b) Local 1,030 (c) Regional 366 Other operations—(a) Permanent Teeth 1,102 (b) Temporary Teeth 2,669 84 TABLE 22 SPECIAL DENTAL TREATMENT UNDERTAKEN BY DENTAL OFFICERS Number of impressions, etc. 24 Number of dentures fitted 10 Number of radiographs (a) at Dental Clinics 27 (b) at Hospitals — TABLE 23—INFESTATION WITH VERMIN Total number of examinations 33,417 Total number of pupils found to be infested 86 Total number of individual pupils found to be infested for the first time during current year 47 TABLE 24 EMPLOYMENT OF CHILDREN AND YOUNG PERSONS 1. Number of children medically examined in order to ascertain whether they were physically fit to undertake employment of a light nature outside school hours 185 2. Number of instances in which the state of health was found to be such that certificates were withheld 1 3. Number of children examined as to fitness to take part in entertainments 8 4. Number of cases in which certificates to take part in entertainments were withheld - TABLE 25 EDUCATION ACT, 1944—Sections 57(3), 57(4) and 57(5) Cases dealt with under Section 57, Education Act, 1944:— Sub-Section 3 5 Sub-Section 4 - Sub-Section 5 4 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act, 1948: TABLE 26—MEDICAL EXAMINATION OF TEACHERS Number of Teachers examined as to fitness for appointment 10 85 TABLE 27—CHIROPODY AGES BOYS GIRLS 0-5 5-10 10-15 Total 0-5 5-10 10-15 Total Attendances: First 6 11 13 30 2 10 66 78 Subsequent 13 33 101 147 14 34 291 339 Conditions—Cases treated at Clinic Flat Feet - - 1 1 - — 1 1 Callosity - - 1 1 - - 3 3 Corns 5 4 7 16 - 4 29 33 Bursa of Heel - - - - - - 1 1 Deviation Great Toe - - - - - - 5 5 Foot wart - 6 9 15 3 4 31 38 Pain in forefoot - - - - - - 1 1 Ingrowing Nail 1 - 1 2 - - 3 3 Pain in Hallux Joint - - - - - - 3 3 Valgus Feet - 1 - 1 - 1 2 3 Hooked Nail - - 1 1 - 1 - 1 Exostosis of Heel - 1 - 1 - - 1 1 Ramshorn Nail - - - - - 1 1 2 Hammer Toes - - - - - - 1 1 Epidermophytosis - - - - - - 2 2 Conditions—Cases referred to Orthopaedic Clinic Hammer Toes - - - - — — 1 1 Valgus Feet - 1 - 1 - - 2 2 Flat Foot - - 1 1 - - 1 1 Deviation Great Toe - - - - - - 3 3 Pain in Hallux Joint - - - - - - 3 3 86 87 TABLE 28—HANDICAPPED PUPILS CATEGORY ASCERTAINMENT DISTRIBUTION (as at last day of year) No. of ascertained Cases known 1st day of Year No. of New Cases ascertained during Year No. of ascertained Cases known last day of Year In Special Day Schools In Special Residential Schools In Maintained Primary and Secondary Schools In Independent Schools Not at School TOTAL B G B G B G B G B G B G B G B G B G Blind Pupils 1 - 2 - 3 - - - 3 - - - - - - - 3 - Partially Sighted Pupils - 3 - 4 - 7 - 5 - 1 - - - - - 1 - 7 Deaf Pupils 1 1 - - 1 1 - 1 1 - - - - - - - 1 1 Partially Deaf Pupils 6 4 1 4 5 6 4 2 1 1 - 2 - - - 1 5 6 Delicate Pupils 11 13 21 11 9 5 - 1 5 4 4 - - - - - 9 5 Diabetic Pupils - - - - - - - - - - - - - - - - - - Educationally Sub-Normal Pupils 35 17 5 5 34 20 20 13 4 - 9 5 - - 1 2 34 20 Epileptic Pupils 2 2 - - 1 1 - - 1 - - 1 - - - - 1 1 Maladjusted Pupils 45 15 2 2 23 8 - - 5 4 18 4 - - - - 23 8 Physically Handicapped Pupils 3 4 4 - 7 2 5 2 - - 1 - - - 1 - 7 2 Pupils with Speech Defects 82 33 84 25 117 41 - - - - 103 41 2 - 12 - 117 41 Pupils with Multiple Defects 2 - - - 2 - - - 1 - - - - - 1 - 2 - TOTALS 188 92 119 51 202 91 29 24 21 10 135 53 2 - 15 4 202 91 GRAND TOTALS 280 170 293 53 31 188 2 19 293 Children not ascertained as H.P. but recommended convalescence in Holiday Home or Camp School during year ended 31st December, 1952. B G 18 15